AEROSPACE MEDICINE YOU - and - January February 2022
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January/February 2022
AEROSPACE
MEDICINE and
YO U
Federal Aviation 8 BasicMed is 11 ow to Fast-Track
H 22
Who’s Who in the Office
Administration Turning Five! Your Medical of Aerospace Medicine
January/February 2022 1
ABOUT THIS ISSUE…
U.S. Department
of Transportation
Federal Aviation
Administration
ISSN: 1057-9648
FAA Safety Briefing
January/February 2022
Volume 61/Number 1 The January/February 2022 issue of FAA Safety Briefing focuses
on aerospace medicine. Articles discuss the pilot medical certi-
Pete Buttigieg Secretary of Transportation fication process and the various roles and responsibilities of the
Steve Dickson Administrator FAA’s Office of Aerospace Medicine.
Chris Rocheleau Acting Associate Administrator for Aviation Safety
Robert C. (Rico) Carty Acting Executive Director, Flight Standards Service
Susan K. Parson Editor
Tom Hoffmann Managing Editor
James Williams Associate Editor / Photo Editor
Jennifer Caron Copy Editor / Quality Assurance Lead
Paul Cianciolo Associate Editor / Social Media
John Mitrione Art Director
Published six times a year, FAA Safety Briefing, formerly
FAA Aviation News, promotes aviation safety by discussing current technical,
regulatory, and procedural aspects affecting the safe operation and Contact Information
maintenance of aircraft. Although based on current FAA policy and rule The magazine is available on the internet at:
interpretations, all material is advisory or informational in nature and should www.faa.gov/news/safety_briefing
not be construed to have regulatory effect. Certain details of accidents
described herein may have been altered to protect the privacy of those involved. Comments or questions should be directed to the staff by:
• Emailing: SafetyBriefing@faa.gov
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2 FAA Safety Briefing
D E PA R T M E N T S
2 Jumpseat: an executive policy
perspective
The FAA Safety Policy Voice of Non-commercial General Aviation
3 ATIS: GA news and current events
Aeromedical Advisory: a checkup on
5
all things aeromedical
6 Condition Inspection: a look at
specific medical conditions
26 Checklist: FAA resources and safety
reminders
27 Drone Debrief: drone safety roundup
28 Nuts, Bolts, and Electrons: GA
maintenance issues
29 Angle of Attack: GA safety strategies
30 Vertically Speaking: safety issues for
Who’s Who in the Office of Aerospace Medicine rotorcraft pilots
22 A Behind-the-Scenes Look at the FAA’s Aerospace Medicine Decision Makers 31 Flight Forum: letters from the Safety
Briefing mailbag
32 Postflight: an editor’s perspective
Inside back cover
FAA Faces: FAA employee profile
Smooth is Fast The Human Factor
11 How to Speed Up Your
Medical Certification
15 How The FAA’s Medical and Human
Factors Research Helps Aviation
BasicMed is Turning Five!
8
How It Works, and How It’s Making a Difference
18 Courses, Sources, and Training Resources
What Pilots Can Learn from the FAA’s Aerospace
Medical Education Division
January/February 2022 1
JUMPSEAT ROBERT C. (RICO) CARTY, FLIGHT STANDARDS SERVICE ACTING EXECUTIVE DIRECTOR
PILOT MAINTENANCE
If you are anything like me, you as the traditional avenues to medical
probably think of going to the doctor certification) is about using open
with the same kind of reluctance you communication with your provider to
might have for, say, launching into find any health problems that could
lousy weather. But where avoiding adversely affect your ability to oper-
bad weather in a small GA airplane ate an aircraft safely, to use the most
can help you stay alive, skipping or appropriate treatments to fix those
delaying visits to your doctor could problems, and to monitor results to
have the opposite effect. ensure that any health/safety issues
A key part of remaining physically are fully resolved.
healthy is an activity that is similar to
the things you do to keep your airplane Questions?
mechanically sound: constant monitor- There are lots of resources available
ing and regular maintenance. One of nowadays from both the FAA and
the earliest skills we learn as pilots is to aviation community organizations.
recognize and address small signs (e.g., If you think you might have an issue,
why is that gauge reading low?) before here are some things you can do.
they become big problems (e.g., my Get the facts. Use all available
engine just quit!). Regular visits to the Second is the FAA’s Compliance resources to learn as much as you can
doctor are an important part of keeping Program, first introduced in 2015. about the certification implications
your flying physiology in top form, so The Compliance Program is the of your particular medical condition.
you can find and address little problems enabling guidance for the FAA’s risk- A good place to start is the medical
before they become more serious. based oversight approach to compli- certification home page on the FAA’s
Many pilots, though, have perhaps ance. It stresses a problem-solving website (www.faa.gov/pilots/medical).
been hesitant to fully communicate approach where enhancement of the You can also access the FAA MedX-
with their doctors for fear of compli- individual or organization’s safety Press form from this page.
cating issuance of the all-important performance is the goal. It promotes Use your resources. The Aircraft
medical certificate. But we have all communication, collaboration, and Owners and Pilots Association
benefited from several developments proactive risk management to find (AOPA), the Experimental Aircraft
over the past few years. safety problems before they cause an Association (EAA), and many other
accident and use the most effective aviation organizations provide med-
Continuous Improvement tools to ensure a positive, permanent ical certification information, advice,
First is the hard work the FAA’s med- fix. This approach certainly applies to and advocacy for their members.
ical certification staff has done over managing your health. It has always Resolve the problem. Work with
the past few years, not only to speed been the case that the FAA expects your physician to resolve any issues
consideration of special issuance compliance on medical requirements, that might delay issuance of your
but also to expand both the range of and it has always been the case that medical certificate.
certifiable conditions and the avenues compliance includes honest com- Document. Learn exactly what the
available. These include AASI (AME munication about issues that affect FAA needs to certify your condition.
Assisted Special Issuance) and CACI your health, and thus your ability to Have your physician document your
(Conditions AMEs Can Issue). The operate an aircraft safely. condition, your treatment, and your
list of CACI-eligible conditions is Third is the advent of BasicMed. prognosis in precisely the format and
expanding and, as you will read else- BasicMed leaves no excuse for any- level of detail the FAA requires.
where in this issue, all kinds of other thing but a full and frank discussion Doing your part will speed the FAA’s
improvements to the medical certifi- with your state-licensed physician evaluation and get you back on the
cation process are in the works. about your health. BasicMed (as well flight deck as quickly as possible.
2 FAA Safety Briefing
GA NEWS AND CURRENT EVENTS ATIS
AVIATION NEWS ROUNDUP
Open and Close Flight Plans via The enhancement is available to your account. If you call from a differ-
Phone all pilots who have a free online ent phone number, the system cannot
Leidos Flight Service released a new 1800wxbrief.com account linked to a look up your flight plan.
feature that allows pilots to activate primary phone number. To sign up for Note that the IVR system will not
and close VFR flight plans via the an account, click Create Account and offer services if it detects more than
Interactive Voice Response (IVR) enter a primary phone number associ- one proposed flight plan with the
system without talking to a special- ated with your account. same departure time, and pilots will be
ist. This upgrade makes opening and When you call 1-800-WX-BRIEF, unable to use the system to close flight
closing VFR flight plans easier than the system will automatically search plans that have entered Search and
ever and saves pilots valuable time by to see if you have a flight eligible to Rescue status. Visit 1800wxbrief.com
eliminating hold times. Activate or Close and provide menu to learn more about the IVR feature
options. The sys- and future updates.
tem will not offer
these menu options Dangerous Laser Strikes Continue
if there is no flight to Rise
plan on file. You Shining a laser at an aircraft is a serious
can activate your safety threat that continues to rise. As
VFR flight plan of Oct. 14, the FAA has received 7,186
up to 30 minutes laser strike reports for 2021, exceeding
in the future to the 2020 total of 6,852. This marks the
ensure that you highest number of reports since 2016.
have enough time Several types of high-powered
to get into the air lasers can completely incapacitate
before the flight pilots, many of whom are flying air-
plan is active. planes with hundreds of passengers.
You can easily People who shine lasers at aircraft
close a flight plan face FAA fines of up to $11,000
when your flight per violation and up to $30,800 for
has concluded multiple laser incidents. In 2021, the
by calling Leidos FAA issued $120,000 in fines for laser
Flight Service from strikes. Violators can also face crimi-
the primary phone nal penalties from federal, state, and
number linked to local law enforcement agencies.
SAFETY ENHANCEMENT TOPICS Please visit bit.ly/GAFactSheets for more information on these and other topics.
JANUARY FEBRUARY
ADM and Startle Response — Stall/Spin/Upset Recovery
Understanding the human startle Training —
response and effectively coping How training and education in
with unexpected events. stalls, spins, and upset recovery
can help reduce loss of control
accidents.
January/February 2022 3
ATIS
To identify laser strike trends, the data reporting and forecasting America (BFA) on an accreditation
FAA developed a visualization tool — including continued testing of program. The program includes
using the Tableau software platform Visual Weather Observation Systems voluntary standards for pilots and
that shows laser strike data from (VWOS), expanding satellite-based operators and offers multiple tiers of
2010 to 2020 and highlights trends Automatic Dependent Surveil- BFA safety accreditation.
by geographic area, per capita data, lance-Broadcast (ADS-B) air-traffic You can find the draft medical
and time of day and year. The FAA control coverage to more areas, and rule in the Federal Register at
shares the information to draw improving navigation charting. The bit.ly/NPRM-balloon, and the public
attention to the dangerously high FAA will begin developing a roadmap comment period closes on Jan. 18.
rate of laser strikes on airplanes. for implementing the recommen-
You can download laser report data dations in the near- and mid-term, Three Military Airports Now
by year from the FAA’s website at focusing on initiatives with the great- Eligible for Funding to Add Civilian
faa.gov/about/initiatives/lasers/laws. est safety benefits. Operations
The FAA remains vigilant to The FAA will develop a draft road- The FAA has selected three airports
raise awareness about the dangers map by mid-February 2022, identify to be eligible for grants to add civil-
of pointing lasers at aircraft and the resources necessary to implement ian aviation operations at former
encourages the public to report laser it and seek aviation stakeholder feed- and current military airfields, adding
strikes (bit.ly/LaserRpt) to the FAA back on the roadmap through May system capacity and helping to reduce
and local law enforcement agencies. 2022. The FAA will continue those congestion at existing airports. Kelly
initiatives already underway and Field in San Antonio, Texas; Mobile
Increasing Aviation Safety in Alaska incorporate parts of the new initia- Downtown Airport in Mobile, Ala.;
Last October, the FAA released tives by summer 2022. The agency will and Salina Regional Airport in Salina,
recommendations (faa.gov/alaska) submit a progress report to stakehold- Kan., can now apply for Airport
on how to increase aviation safety in ers by September 30, 2022. Improvement Grants.
Alaska after a year-long, sweeping The Military Airport Program
examination of safety issues specific Proposed Medical Requirements for (MAP) provides funding as a set aside
to the challenges of flying in Alaska, Commercial Hot-Air-Balloon Pilots of the Airport Improvement Program
where more than 80% of its commu- In November, the FAA proposed a rule (AIP) to help increase civilian aviation
nities are accessible only by air. requiring commercial hot-air-balloon capacity at current or former military
Among the recommendations are: pilots to hold medical certificates airports. MAP funds projects such
increasing and improving weather when operating for hire. The rule as surface parking lots, fuel farms,
would mandate a sec- hangars, utility systems, access roads,
ond-class medical certificate, cargo buildings, and other airfield-re-
the same standard required lated infrastructure.
for commercial pilots. The MAP allows the FAA to des-
Currently, commercial ignate up to 15 joint-use or former
balloon pilots are exempt military airports to participate each
from the medical require- fiscal year. Three of the 15 airports
ment. In the FAA Reau- may be general aviation airports, and
thorization Act of 2018, the remaining 12 must be commercial
Congress directed the service or reliever airports. Selected
FAA to revise the medical airports are designated for a period of
certification standards for one to five years. Previously selected
commercial balloon pilots. airports may re-apply to the program.
The draft rule also addresses The airports in this program have
a NTSB recommendation unique project-eligibility rules to
that the FAA remove the convert them to civilian or joint use,
exemption. thereby increasing the capacity of the
The FAA in recent years National Airspace System to serve
took steps to increase the the flying public. Since 1991, the FAA
safety of hot air balloon has provided approximately $764
tourism by working with million to more than 35 airports
the Balloon Federation of through the program.
4 FAA Safety Briefing
DR. SUSAN NORTHRUP, FAA FEDERAL AIR SURGEON AEROMEDICAL ADVISORY
MIND YOUR MEDS!
Pilots often ask which medications are against kidney disease in individuals Do Not Fly list in the AME Guide
permissible for flight and where they with diabetes. It can be acceptable for (bit.ly/NoIssueOrFly).
can find this information. all of these conditions. Hydrocodone/Acetaminophen
Let’s check out some of the top Albuterol (Accuneb®, Ventolin, (Lortab®, Vicoden®, Norco®): these
prescription medications in the Proair®, Proventil®): this medication pain medications can cause sedation
United States (according to GoodRx. is used to treat wheezing and short- and/or dizziness and are unacceptable
com) and review how we consider ness of breath from asthma or COPD. for flight. Besides, if you need a nar-
them for medical certification. Review the CACI Asthma worksheet cotic pain medication, you shouldn’t
Here's a link to the Pharmaceuticals (bit.ly/CACIAsthma) (PDF), and be flying. These medications are also
(Therapeutic Medications) section of bring a copy to your personal doctor, found on the DNI-DNF list and in
the AME Guide for further guidance so they know which medications are the Medications and Flying brochure
(bit.ly/AMEGuideTherapeutics). acceptable for flight. Be sure to tell (bit.ly/MedsFlying) (PDF).
your AME what you use, how often Diphenhydramine (Benadryl®):
Usually Acceptable: you use it, and why. this is a common component in over-
Atorvastatin (Lipitor®): this medica- Levothyroxine (Synthroid®, Uni- the-counter (OTC) sleep medications,
tion is used for high cholesterol and throid®, Levoxyl®): this medication is many cough and cold combination
is allowed if the user experiences no used for hypothyroidism. Review the medications, and some allergy medi-
significant side effects. Like any accept- CACI Hypothyroidism Worksheet cations. It is the most common medi-
able medication, wait at least 48 hours (bit.ly/CACIHypothyroidism) (PDF). cation seen in fatal aircraft accidents.
(some need a longer ground trial) after Provide a copy to your personal doc- If you take it, you should not fly for
the first dose to make sure you have no tor to help ensure that their clinical 60 hours after the last dose. If you
problems with the medication. note includes the information we need need a medication for a cold, flying is
Lisinopril (Prinivil, Zestril): for medical certification. not a good idea anyway. For accept-
an angiotensin converting enzyme Metformin (Glucophage) for Dia- able allergy medications, check out
inhibitor (ACE-I) used for high betes: check out the Acceptable Com- the Allergy — Antihistamine page
blood pressure or heart failure. Most binations of Diabetes Medications (bit.ly/AllergyAntihistamine) (PDF).
high blood pressure medications are (bit.ly/ComboDiabetesMeds) (PDF).
allowed after a seven day ground This two-page chart lets you, your OTC Medication Example:
trial. Review the disposition tables AME, and (if you bring them a copy) Omeprazole (Prilosec): this is an
here (bit.ly/HeartHypertension) to your personal physician know what OTC medication used to reduce
see what information you need from medications the FAA allows for pilots stomach acid in many underlying
your personal physician for your and how long you must wait to return conditions like heartburn, GERD,
AME to issue a medical certificate to active flying after starting, adding, or ulcers. It is also available as
under Conditions an AME Can Issue or changing diabetes medication. a prescription medication in a
(CACI). Another resource is this FAQ higher dose. If you need an OTC
page (bit.ly/HeartHypertensionFAQs) Unacceptable for Flight: medication, start here: What OTC
(PDF) which you’ll also find helpful Gabapentin (Neurontin®): used medications can I take and still be
for these next two medications. for seizures, nerve pain, or shingles safe to fly? (bit.ly/OTCMedstoFly)
Amlodipine (Norvasc®): a calcium pain, this medication can make you When in doubt about medications,
channel blocker (CCB) used for high drowsy or dizzy, may slow your ask your AME. Your personal physi-
blood pressure. If you take it for any thinking, and cause loss of coor- cian might not understand the impli-
other reason, let your AME know why. dination. In fact, the prescription cations of many medications and/or
Losartan (Cozaar): an angiotensin insert warns you not to drive a car or conditions for flight safety. Ask them
II receptor blocker (ARB) used for operate heavy machinery. Neurontin a simple question — Would they feel
high blood pressure. It also reduces and similar sedating medications are safe on an airplane if THEIR pilot was
the likelihood of stroke and protects referenced on the Do Not Issue — using this medication?
January/February 2022 5
CONDITION INSPECTION CHRIS M. FRONT, PSY.D. AND RANDY J. GEORGEMILLER, PH.D.
PILOTS WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD)
Safety experts agree that at least 70% easily distracted, wandering off task, suming process. Medical providers,
of aviation accidents are attributable and having difficulty sustaining focus. acting under time pressure and
to the pilot. NASA scientists report Hyperactivity refers to excessive motor attempting to respond to the concerns
that most accidents result from some activity or excessive restlessness, or of patients (or their parents), some-
failure in the pilot’s cognitive perfor- talkativeness. Impulsivity refers to times prescribe medication to treat
mance, with distractions and errors in hasty actions without adequate con- ADHD or assign a diagnosis without
aeronautical decision making (ADM) sideration of possible consequences, adequate evidence of the disorder. The
most prominent. despite a high potential for harm. result is a subset of the adult pop-
For example, when a pilot decides NTSB investigations of fatal ulation with a documented history
to launch into marginal VFR con- accidents attributed to ADHD have of treatment for ADHD — some of
ditions, continues as conditions documented that pilots with ADHD: whom truly had the condition and
deteriorate, enters IMC, and loses failed to adequately prepare for flight others who probably did not.
control of the aircraft, the fatal crash (e.g., did not check the weather), con- To determine if the adverse
may be categorized as a “loss of con- tinued flight when it was ill-advised impact of ADHD is present or not,
trol” event, but it was rooted in poor (e.g., due to deteriorating weather), the FAA requires a thorough evalu-
ADM. Even experienced pilots with engaged in hazardous actions (e.g., ation by a licensed psychologist. It
no impairing conditions occasionally low-level maneuvering to show off), is most beneficial to see a psycholo-
make errors in ADM or get dis- and became distracted and made criti- gist familiar with the FAA’s specific
tracted. That fact led to the emphasis cal errors (e.g., failed to maintain air- protocols and standards. AMEs
on CFIs creating realistic distractions speed, stalled, and spun while circling have access to a list of FAA-eligible
in flight to teach effective distraction a friend’s home at low altitude). Due providers to assist with referrals. The
management, as well as scenar- to the risks to flight safety posed by FAA’s evaluation requirements for a
io-based training and formal risk ADHD, regulatory authorities world- history of ADHD are available at the
assessment tools to improve ADM. wide consider ADHD a disqualifying following link: bit.ly/AMEGuide.
The likelihood of an accident condition for pilots. Upon review, the FAA will either
rooted in distraction or poor ADM Unfortunately, pilots sometimes fail deny the pilot’s application or grant
is heightened when the pilot has a to disclose ADHD to their Aviation an unrestricted or Special Issuance
condition that negatively affects such Medical Examiner (AME). The result (SI) medical certificate. If the pilot
skills. Attention-Deficit/Hyperactivity is that the FAA learns about the con- receives a time-limited SI, further
Disorder (ADHD) is a neurodevel- dition after a fatal accident when the monitoring and assessment may be
opmental disorder with symptoms of toxicology results reveal the presence required. While time-consuming
inattention and/or hyperactivity-im- of medication used to treat ADHD. and costly, based on the safety risks
pulsivity that interfere with function- Notably, pharmacological treatments posed by the symptoms of ADHD,
ing or development. ADHD occurs for ADHD are not approved for flying the FAA has established this evi-
in approximately 5% of children and because they can cause harmful effects dence-based risk assessment proto-
frequently persists into adulthood, on perceptual, motor, and cognitive col to safeguard both the pilot and
affecting about 2.5% of adults. functions and impair the recognition the national airspace system.
Three subtypes of ADHD are based of fatigue. Additionally, their effec-
on the symptoms exhibited: a “pre- tiveness is time-limited, a particular Chris M. Front, Psy.D., is an instrument and multi-engine-
dominantly inattentive” presentation, concern if a dose is missed or flight rated commercial pilot and clinical psychologist in the
a “predominantly hyperactive/impul- time exceeds the therapeutic impact FAA’s Office of Aerospace Medicine. He is board certified in
assessment psychology. Randy J. Georgemiller, Ph.D., is a
sive” presentation, and a “combined” of the drug. neuropsychologist in the FAA’s Office of Aerospace Medicine
presentation. All three include symp- Complicating the picture is the fact and is board certified in clinical psychology.
toms that pose a hazard to flight safety. that an inaccurate diagnosis of ADHD
Inattention manifests behaviorally is not uncommon. Proper diagnosis
in ADHD as being disorganized, of ADHD is a complex and time-con-
6 FAA Safety Briefing
FROM
THE
FLIGHT
DECK
FEDERAL AVIATION ADMINISTRATION
PRODUCTION
know before you go.
faa.gov/go/fromtheflightdeck
NOW PLAYING
BasicMed
Is Turning
Five!
How It Works,
and How It’s Making a Difference By Tom Hoffmann
O
n May 1, 2017, the FAA ushered in a new alternative costs and enhancing the convenience and efficiency of the
to airman medical certification. BasicMed marked a medical certification process.
tremendous shift in how some pilots can meet required
medical qualifications for conducting lower-risk, non-com- The Requirements
mercial flying. Nearly five years later, more than 50,000 pilots BasicMed has specific requirements for the airman, the
(myself included) are currently flying under BasicMed. type of aircraft you fly, and the type of operations you can
While it has been popular for many pilots to pursue perform. Here’s the breakdown:
this alternative medical certification, some users still have
Airman: You’ll likely qualify for BasicMed (most pilots
a learning curve, especially as many near the first set of
do), but here’s what you’ll need:
renewal periods for operating under BasicMed. We can
help. We’ll review key steps you’ll want to consider for both • A current and valid U.S. driver’s license.
starting and maintaining BasicMed coverage. We’ll also • A valid FAA medical certificate, held at any point after July
look at some of the research the FAA has completed in its 14, 2006. If that medical certificate was associated with
five-year look back report to Congress to see how the pro- a Special Issuance, the expiration of the Special Issuance
gram is making a difference in the aviation community. must be after July 14, 2006. Your most recent medical
certificate must not have been suspended or revoked, and
The Basics any Special Issuances must not have been withdrawn. Also,
BasicMed permits certain pilots flying certain aircraft if you’ve since applied for another medical certificate, that
to conduct certain operations without holding a current completed application cannot have been denied.
medical certificate. (Don’t worry, we’ll be “certain” to explain • Pilots who have ever had certain mental, cardiac, or
those conditions below.) It is important to recognize upfront neurological health conditions will need a one-time-only
that BasicMed is an alternative to the third-class medical Special Issuance medical certificate for each condition.
certificate. It is not a replacement, and it is not a “fourth- Suppose you haven’t had a Special Issuance for that
class” certificate. condition, and you currently have, or you are newly
Relief measures that come with choosing BasicMed diagnosed with, one of the cardiovascular, neurological,
include using a valid U.S. driver’s license as a means or mental health conditions described in the list of spe-
of maintaining medical compliance with the program cial conditions. In that case, you may not use BasicMed
(provided you’ve held an FAA medical after July 16, 2006) until you have been issued a medical certificate with an
and using a state-licensed physician (like your regular authorization for Special Issuance. For the list of special
family doctor) to perform the exam and sign off on your conditions, see Medical Conditions Requiring One Spe-
fitness for flight. Both provisions were aimed at lowering cial Issuance at faa.gov/go/basicmed.
8 FAA Safety Briefing• Aircraft: Under BasicMed, you may fly aircraft that: sive Medical Examination Checklist (CMEC) found here:
• Has a maximum certificated takeoff weight of not more bit.ly/BasicMedCMEC. If the section you’re required to fill
than 6,000 pounds. out looks familiar, it should — it’s derived from a previous
version of FAA Form 8500-8, the medical certificate appli-
• Is authorized under federal law to carry not more than
cation form that now exists in MedXPress.
six occupants. Please note that in the last four years,
Section 2 of the form requires you to answer questions
supplemental type certificates are now available for
about your medical history. Your physician will review
certain aircraft certificated for more than six seats so that
your responses to those questions and address any medical
they qualify for BasicMed. Visit the main FAQ for more
issues or medications taken as they apply to operating an
details at bit.ly/BasicMedFAQ.
aircraft or motor vehicle. Your physician will also conduct a
medical examination of the items listed in section 3. These
items are similar to what an Aviation Medical Examiner
would check for during a third-class medical exam.
If your physician is satisfied that you present no medical
conditions that would interfere with your ability to safely
operate an aircraft, they will complete and sign the form,
including their state license number. Legibility is key as you
will need this information to print your medical education
course completion certificate. Store the completed CMEC
in your logbook.
If you’re considering BasicMed for the first time, or if
perhaps you’ve switched doctors recently and need to get
renewed, have a look at the article in our July/August 2017
issue titled “Doctor, Doctor, Let Me Give You the News”
Operations: BasicMed permits flights of any distance or (spark.adobe.com/page/fjIC3oWxhMgcv). It provides
duration, any time of the day, under visual or instrument excellent advice for how to approach your doctor about the
flight rules, but there are a few operational limitations: BasicMed process.
• No more than five passengers, regardless of the number Finally, remember that to act as PIC under BasicMed, you
of seats. must have completed a medical examination in the pre-
• No flying above 18,000 feet mean sea level (MSL) or ceding 48 months. As I write, I’m days away from my first
beyond 250 knots (indicated). BasicMed recheck with my doctor — a gentle prod from my
BasicMed online course provider was a helpful reminder.
• No flights outside the United States. Filling out the CMEC was easy. Just be sure to note any
• No operations for compensation or hire (note: flight recent conditions (including COVID-19 infections), medi-
instructors may receive compensation for instructing while cation changes, and any visits you made to a health profes-
operating under BasicMed). sional in the last three years. Your doctor should be able to
complete and sign the form during your checkup.
The Appointment
Okay, so you’ve established that you, your airplane, and The Online Course
the types of flying you do are covered under BasicMed. The final step is completing the BasicMed online medical
Next up is an appointment with a state-licensed physician course and quiz. There are currently two course provid-
of your choice (preferably one who’s familiar with your ers (AOPA and the Mayo Clinic), and links to each are
medical history). Before the appointment, you must first on faa.gov/go/basicmed. The course is required every 24
complete your portion of FAA Form 8700-2, Comprehen- months to remain covered under BasicMed, but it’s not
a bad idea to review the material more often. Once you
complete the course, you will be required to enter informa-
tion about yourself and the physician who completed the
CMEC. You’ll also need to electronically certify that you:
• Allow the FAA to access your driving records,
• Are being actively treated for any medical condition that
affects your ability to fly,
• Have completed the CMEC, and
January/February 2022 9hours, which showed an equivalent activity level before and
after the study period.
In terms of airmen, the study indicates that BasicMed
has returned approximately 30,000 airmen to flying status.
Data also revealed that BasicMed pilots are older than the
average pilot with a Class III medical (61 years) and are
much more likely to have required a Special Issuance.
While this data could suggest that pilots using Basic-
Med are in a higher category of risk for incapacitation
and medically-related deaths, that’s not the full picture.
Notably, the study concluded there was no difference in
the risk for BasicMed and third-class airmen to have an
aviation accident. Their report also found no difference
between these two groups when looking at the accident
phase of flight, fatal versus non-fatal outcomes, and fatal
injury autopsy results. It is still early, though, so the FAA
will continue to monitor trends.
“BasicMed is a great example of the FAA applying risk-
based regulation and oversight, shifting responsibility back
to the pilot,” says FAA Aviation Safety Analyst Brad Zeigler,
who is also the General Aviation and Commercial Divi-
sion’s BasicMed program lead. “This responsibility allows
There are currently two options for the online BasicMed course — AOPA and the Mayo Clinic.
the pilot to work openly with their physician to objectively
Links to each are on faa.gov/go/basicmed. assess medical fitness for flight.”
In the end, safety depends on the airman to accurately
• Understand your obligations under 14 CFR section and honestly assess fitness for flight before getting into
61.53 regarding the operation of an aircraft during a the flight deck, no matter how recent your last checkup
medical deficiency. was (use the IMSAFE checklist). Whether you operate
under BasicMed, or with an FAA medical, remember that
When you click submit, this information is transmitted
14 CFR section 61.53 prohibits you from acting as PIC if
to the FAA, and you will get a course completion certificate
you know, or have reason to know, of any medical condi-
to retain in your logbook.
tion that would make you unable to operate the aircraft
in a safe manner.
A Checkup on BasicMed
If you have any questions or comments about the
As part of the FAA Extension, Safety, and Security Act FAA’s BasicMed rule, please contact us at
of 2016 that created BasicMed, the FAA, in coordination 9-AWA-AFS-BasicMed@faa.gov. You can also find answers
with the National Transportation Safety Board (NTSB), is to frequently asked questions at bit.ly/BasicMedFAQ.
required to submit a report to Congress that “describes the
effect of the regulations issued or revised […] and includes Tom Hoffmann is the managing editor of FAA Safety Briefing. He is a commercial pilot and
statistics with respect to changes in small aircraft activity holds an A&P certificate.
and safety incidents.” In response to this mandate, the FAA
and NTSB have just completed a report summarizing find-
LEARN MORE
ings of the first three years of operations under BasicMed.
The report considered survey data for airmen, aircraft,
FAA BasicMed webpage
and flight operations most closely correlated to operations
faa.gov/go/basicmed
conducted under BasicMed, and looked at shifts in accident
trends in this same general category of operations. So did Advisory Circular 68-1A, BasicMed
BasicMed lead to more pilots flying more airplanes in this bit.ly/BasicMedAC
category? Was there any measurable impact on safety?
Aviation Medical Examiner Guide
In terms of aircraft, BasicMed did not appear to impact bit.ly/AMEguide
the number of aircraft most likely to be operated under
BasicMed. There was modest growth in four years before AOPA BasicMed Eligibility and Renewal Tool
implementation; numbers subsequently stabilized. There bit.ly/AOPABMRenewal
was also no measurable impact on the number of flight
10 FAA Safety BriefingSm o o t h is Fast
How to Speed Up Your Medical Certification
By James Williams
T
here is an idiom that says, “Slow is smooth. Smooth records. Also, make sure your contact information is cur-
is fast.” The expression was made famous by special rent in MedXPress.” These tips help any pilot looking for a
operations soldiers to emphasize that slowing down to medical, whether for a renewal or an initial application (for
smooth out the process will paradoxically often lead to a more on what to expect from your first medical exam, see
faster end result. As Tolkien said, “the hasty stroke oft goes the article “What to Expect From an FAA Medical Exam”
astray.” Both sayings are very relevant to our medical certi- here: bit.ly/FAAMedExam).
fication. So by rushing the process, you may find yourself
in a far more frustrating ordeal than is necessary. In fact,
the vast majority of medical certificate applications that are
not issued are based on a lack of response from the airman
with the requested information, not a denial by the FAA.
So, in a very real way, taking some time to slow down and
ensure a smooth process could make a huge difference.
Smoothing Out the Process
“There are some very simple things a pilot can do to
streamline the process,” explains Federal Air Surgeon (FAS)
Dr. Susan Northrup. “First, make sure any documents
you submit to the FAA are legible and have your name, a
date, and any identification numbers that you may have
on them.” She continued, “Make sure all letters, including
summaries from physicians, are signed and dated. Ensure
that your package includes all information requested by
the FAA and keep a copy of what you’ve submitted for your
January/February 2022 11Guiding Your Path
Dr. Northrup also has another piece of good advice. “The
Guide for Aviation Medical Examiners (AME) is a great
resource for pilots to see what the FAA requires to certify
a pilot with any given condition.” The Guide for Aviation
Medical Examiners is the AME’s manual for the medical
certification of pilots. While the AME Guide was written for not Special Issuance certificates, that usually come with
doctors, it is available to anyone online at bit.ly/AMEGuide. limited durations or additional requirements. These con-
So if you want to know what your AME is going to be look- ditions include arthritis, asthma, hypertension, migraines,
pre-diabetes, several forms of cancer, and more. For a
Regardless of what certification path complete list of conditions and the applicable worksheets,
you end up taking, slowing down to visit bit.ly/AMECACI.
ensure a smooth process will likely Special Issuance, SODAs, and More
deliver the best results. If you don’t meet the regular medical standards, there are
a few other options. The most common would be a Spe-
ing for, the guide is a great place to start. cial Issuance (SI). Broadly, SIs are performed when a pilot
“If you have any questions, or need more help, reach out doesn’t meet the medical standards. Still, through some
to your AME, Regional Flight Surgeon (RFS), or one of the alternate means like additional documentation, shorter
pilot advocacy groups that can provide more information,” duration certificates, additional monitoring, or other miti-
said Dr. Northrup. If you have a condition listed in the AME gations, the FAA can issue an SI so the pilot can fly. Unlike
guide, you can work with your primary care doctor to make a CACI, these medical exams must be initially deferred to
sure that you have current copies of all of the reports and test the FAA and reviewed by the Aerospace Medical Cer-
results. It’s also essential to ensure that any tests ordered are tification Division (AMCD). Under the AME Assisted
correct, and in the format the FAA needs for certification. Special Issuance (AASI) program, some SI renewals may
When in doubt, your doctor may contact your AME or RFS’s
office. This ensures that you don’t have to repeat tests and
are ready to be certificated when you walk into your AME’s
office. But what if you don’t meet the medical standards?
Meet CACI
If you haven’t had a medical certificate before or haven’t
had one in a while, you probably don’t know what a CACI
is. Conditions AMEs Can Issue (CACI) is a program that
allows AMEs to issue medical certificates to pilots that
would usually have to be deferred to the FAA so long as
they meet specific requirements. That means that you
walk out of your AME’s office with a medical certificate
without having to wait for the FAA to review and approve
your medical. Also, these are regular medical certificates,
12 FAA Safety BriefingFive Tips to Fast-Track Your Medical By Dr. Leo Hattrup, FAA Medical Officer
Due to advances in treatment, medical follow-up, and FAA medical programs Caution: A “Patient After Care Summary” is easily accessible on many
and protocols, the FAA now allows pilots to be issued medical certificates with Electronic Medical Records, but this DOES NOT contain what the FAA needs to
medical diagnoses and/or medications that were previously considered ground- make a medical certification decision. The FAA requires a copy of the actual
ing. However, pilots (and the FAA) still want the process to be as fast as possible. clinical treatment records. Also, the FAA does not need a separate letter or
The key is to come prepared for your Aviation Medical Examiner (AME) note from your provider. It is just more work for the provider and usually does
appointment. not include all the information that the FAA needs.
In many cases, your AME will have all of the information needed to issue a 3. Help Your Physician Understand Airman Medical Certification
certificate at your appointment. Still, if any item is missing or a question is There’s a very good chance that the physician who takes great care of you and
unanswered, your medical (if deferred) will take longer. Here are five tips that your medical conditions has no experience in airman medical certification.
can help speed things along. Here’s a few things that will help them help you:
1. L ist ALL Your Medical Conditions, Including Any Physician • Explain that the FAA makes medical determinations based on the Code of
Visits Since Your Last Medical Federal Regulations, which focuses on public safety.
A common mistake that applicants make is not including a complete medical • Let them know what information the clinical records must contain and that
history on their application. The FAA requires a complete list of your current an FAA physician may review it.
medical conditions and history, so be sure to make a list of everything, • Bring a copy of the CACI worksheet for each of your conditions. Let your
including events that happened years ago and those you reported on previous physician know that you need each item addressed in the clinical records.
applications. This list will also help you fill out your Application for Airman • If the FAA specifically asks for an evaluation by your physician, make sure the
Medical in MedXPress (Form 8500-8) and give you a starting point to review clinical records are officially reviewed and signed by your physician and not
what information the FAA will need for each of your conditions. (Remember, just a clinical extender (e.g., nurse, nurse practitioner, physician assistant, etc.).
the instructions state “Have you ever in your life …”) 4. Work With Your AME
Many pilots find it helpful to maintain a list of all doctors visited, including Unlike most physicians, AMEs are specifically trained by the FAA to know
names, contact information, and specialty, along with the treatment received when to issue or defer a medical certificate. When a pilot has a condition
and the condition or reason for the visit. Keep in mind that after you have requiring the AME to defer (such as a heart attack or stroke), your AME can
made an initial report, further reports can be very brief (e.g., “appendectomy, help you understand which documents the FAA will need to review. Remem-
2003, fully recovered”). ber, while both your physician and the FAA are concerned about your health,
the FAA also focuses on public safety. For that reason, we sometimes require
2. What Documents Do I Need to Bring to My Appointment? testing beyond what is necessary just for patient care.
Take a look at the AME Guide at bit.ly/AMEGuide to find out what documents
and information your AME will need to see for each of your medical conditions at If you have a condition that requires a Special Issuance, in some cases, your
your appointment. It will also give you a starting point to help you fill out your AME will be able to issue a follow-up certificate. The FAA has a sub-set (30
MedXPress application. conditions, so far, for all classes) for which the AME can issue a renewal of
the Special Issuance. These are called AME Assisted Special Issuances or AASI,
A helpful tip is to use the CTRL-F key search function within the PDF file to find
though the FAA will still review the evaluation. Assuming the evaluation is
requirements for a specific condition. The disposition tables for each condition
favorable, the pilot can walk out of the office with a certificate in hand rather
in the AME Guide will indicate what documents you need to provide. You should
than waiting for the FAA to complete the review. In the past few months, we
see this under the Evaluation Data section of each table. Watch this AME Minute
added a group of the most common cardiac conditions to the list.
video explaining disposition tables at bit.ly/DispositionTables.
Your condition may require your AME to follow the Conditions an AME Can Issue 5. D on’t Forget to Submit Your Information to the FAA Within
(CACI) worksheet, so be familiar with this document. Many pilots find it helpful 14 days of Your Exam
to bring the CACI worksheets or disposition tables to their treating physician(s) to Due to the volume of documents received by the FAA, if at all possible, send
help them create a note or clinic summary that the FAA can use to make an aero- your documents within the 14-day window that AMEs are allowed for sub-
medical decision. You can find the CACI worksheets here: bit.ly/CACIWorksheets. mitting examinations. Also, note whether you or your AME will be sending
in documents, and ensure your AME gets a copy. Advise the FAA of any
If your condition requires you to provide a “current status report,” please note
delay beyond 14 days.
that we are looking for a copy of the detailed clinical progress notes (actual
clinical records) from your treating provider that should address each of the Approach your medical certification the same way you prepare for a flight. Be
following topics: prepared, use a checklist, and have all the tools and supplies that you need on
hand to fast-track your medical to a smooth landing.
• Diagnosis
• Treatment and Follow-up Plan
• Prognosis
• Specific Items on the Disposition Table
January/February 2022 13be handled by selected AMEs without first deferring to the visit, so there’s no penalty for asking questions before that
AMCD, assuming specific criteria are met. AASI saves time process begins. Hopefully, by knowing what to expect
by not processing on the front end and gets you back to and being ready with any additional information, you can
flying status faster. Please see our Jan/Feb 2009 issue for the reduce a maddening waiting game of frustration to an easy
article “Getting your Special Issuance Medical” for a more visit to your AME that ends with a medical certificate in
detailed look at the SI process. See Learn More for a link. your hand. Even if that isn’t possible, having that additional
A Statement of Demonstrated Ability (SODA) is a pro- information in hand and ready to send to the AMCD
cess that allows a pilot with a static, non-progressive condi- should reduce the need for time-consuming back and
tion that might otherwise be disqualifying to demonstrate forth. This is where a good AME can make a big difference.
that they are capable of operating an aircraft safely despite For more on finding a good AME, see “Building the Right
the disqualifying condition. The scope for a SODA is more Team” on page 5 of our Sep/Oct 2018 issue. You’ll find a
limited than an SI, as the condition must be static but is link in Learn More.
valid until the condition changes or is revoked by the FAA. A smooth and fast certification process is what everyone
This process may require a special medical test flight (this wants, and hopefully, this helps you get there.
might not actually include a flight) to determine that the
pilot can operate safely and what, if any, limitations must be James Williams is FAA Safety Briefing’s associate editor and photo editor. He is also a pilot
placed on the medical certificate. These tests are requested and ground instructor.
by the AMCD or RFS and generally carried out by the local
Flight Standards District Office (FSDO).
Other means of medical compliance include BasicMed, LEARN MORE
Sport Pilot, and aircraft operations that don’t require a
medical certificate. Each of those categories is an article in Guide for Aviation Medical Examiners
bit.ly/AMEGuide
its own right, but it’s important to remember that Title 14
Code of Federal Regulations (14 CFR) section 61.53 still “What to Expect From an FAA Medical Exam,” FAA Safety Briefing — Nov/Dec
applies. This means that you must still ensure that you are 2021, p. 6
fit for flight as pilot in command before each flight. bit.ly/FAAMedExam
Regardless of what certification path you end up taking,
CACI Worksheets
slowing down to ensure a smooth process will likely deliver bit.ly/AMECACI
the best results. If you think you may have difficulty with
the process, check the AME guide to see what the FAA “Getting Your Special Issuance Medical,” FAA Safety Briefing — Jan/Feb 2009, p. 2
needs. This is especially true if you have a CACI condition. faa.gov/news/safety_briefing/2009/media/JanFeb2009.pdf (PDF)
Work with your personal doctor and AME to make sure “Building the Right Team,” FAA Safety Briefing — Sep/Oct 2018, p. 5
everything is in hand, and be sure that’s what the FAA faa.gov/news/safety_briefing/2018/media/SepOct2018.pdf (PDF)
needs to see. If you have questions, ask your AME or RFS.
Also, consider contacting a pilot advocacy group. Many SODA Guidance
bit.ly/SODAGuidance
have excellent advice for navigating the process.
Remember your medical exam doesn’t start until the
AME pulls up the MedXPress application at your office
14 FAA Safety BriefingThe
Human
Factor
How The FAA’s Medical
and Human Factors
Research Helps Aviation
By James Williams
W
hat’s the one thing that runs through all aspects of And that’s been the challenge. Fatigue is hard to measure
human endeavor? The human. Whether the human beyond simply asking the subject directly. It can be hard to
performs or doesn’t dramatically impacts the spot the differences between these states or even identify
outcome and safety of virtually everything we do. Paradoxi- fatigue, even with willing people. If a person is used to only
cally this becomes even more important as systems become sleeping five to six hours per night, they may not realize they
more automated. A pilot’s human performance is key to a are operating at a deficit. Because everyone is different and
safe national airspace system (NAS). That’s why the FAA’s has different sleep needs, and this changes throughout life,
Office of Aerospace Medicine runs research labs focused diagnosis is a challenge. If someone has become accustomed
on both Human Factors and Medical Research. to being fatigued, what they are experiencing is “normal” for
them, and they are unlikely to mention it to a doctor.
The Fatiguing Nature of Fatigue
Fatigue has been a scourge on every facet of aviation Defining the Indefinable
from its inception. Whatever role you play in the sys- The question with a condition like chronic fatigue is how
tem (pilot, maintainer, dispatcher, etc.), fatigue reduces do you detect it, especially when the person may not even
your performance and creates risk in the system. But know that their condition is chronic and that they need to
what’s the difference between just being tired and being report it to a doctor? That’s where a more indirect approach
fatigued? And how could you tell if you are dealing with may be helpful, and biomarkers can play that role.
acute fatigue or chronic fatigue? Being tired might result Biomarkers are measurable biological characteristics that
from staying up too late to watch the end of the game, can serve as indicators of some phenomenon, such as dis-
while acute fatigue might result from a busy week at work. ease, infection, or environmental exposure. Comparable with
Chronic fatigue is likely the result of an ongoing issue, measuring the height of a building by observing its shadow
whether professional, medical, or personal. The solutions and calculating the angle of the sun, biomarkers allow you
to each of these conditions are different so understanding to detect or measure something that you may not otherwise
the difference between them is critical. be able to do. Biomarkers have a variety of applications
January/February 2022 15Vicky White loads samples for extraction of genetic material from blood, a Susan Munster views a pictorial representation of gene expression information,
first step in the measurement of gene expression biomarkers. towards identification of genetic biomarkers related to aviation safety.
and could be a strong indicator of a condition like chronic biomarker can rapidly test drug candidates by rerunning
fatigue, which lacks a standardized laboratory test. For those the test before and after exposing the blood sample to those
suffering from fatigue, having a reliable indicator would be a drugs. This would allow initial testing of drugs with mini-
powerful tool for getting treatment. And for those in indus- mal risk to any human subject.
tries like aviation, any kind of objective early warning system In 2021, Ohio State University announced the identifica-
would be invaluable in the number of lives it could save. tion of the protein deoxyuridine triphosphate nucleotido-
Several organizations, including the FAA, have been hydrolase (dUTPase) as “a key modulator of the immune
pursuing this research for some time. In 2015, units of response that contributes to the immunological and neuro-
the National Institutes of Health (NIH) held a conference logical abnormalities in some individuals.” It suggests that
titled Developing Biomarker Arrays Predicting Sleep and dUTPase could be used as a biomarker of CFS, at least in a
Circadian-Coupled Risks to Health. The workshop brought subset of patients. Ohio State is also working to develop a
together many researchers interested in finding biomarkers high-volume test that would allow for large-scale screening
related to sleep. In 2016, a number of Japanese researchers and early detection of chronic fatigue.
published a paper that showed promise in using oxidative The FAA has been investigating fatigue biomarkers for
stress measures to discriminate participants suffering from a little over a decade. In particular, the FAA’s Functional
chronic fatigue from those who were not. But more work Genomics Team within the Aerospace Medical Research
was needed to define this biomarker. Division is seeking molecular biomarkers associated with
cognitive changes during sleep loss. The FAA published
By working together with industry preliminary candidate biomarkers associated with atten-
and academia, the FAA hopes tion impairment during sleep loss based on a collab-
orative study with Washington State University. Both
to make fatigue a much smaller ongoing studies and future planned investigations aim to
problem in the future. improve and validate initial findings. Research is a highly
detailed process, and vetting the results is both critical
In 2019, researchers from Stanford University devel- and time-consuming.
oped a blood test that could accurately identify people It’s essential to have as much research from as many
with Chronic Fatigue Syndrome (CFS). While the study angles as possible to develop the best possible metrics.
was small (40), the test detected the 20 participants with Especially with a complex phenomenon such as fatigue that
chronic fatigue without any false positives. The test works has a variety of health and performance implications, hav-
by measuring the participant’s blood to determine its ing more than one approach may improve management or
immune cell response to stress. The immune cell response treatment options. By working together with industry and
from those participants suffering from chronic fatigue will academia, the FAA hopes to make fatigue a much smaller
be different from those who are not. The hope is that this problem in the future.
16 FAA Safety BriefingYou can also read
