The Civil Aviation Medical Examiner and You - When You Visit the Medical Examiner

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This is the first article in the aviation medicine section of the new Aviation Safety Letter. It will describe what happens during an aviation medical examination, and why. In coming issues, we will write about various medical conditions and how they may affect the fitness of pilots to fly or air traffic controllers to perform air traffic control (ATC) duty. We welcome your questions and suggestions for topics to explore.

Most pilots and air traffic controllers will need to visit an appointed aviation examiner periodically to obtain or renew a medical certificate (MC). The few exceptions are those healthy enough to answer all questions on a medical declaration form in the negative, and who only desire a category4 MC. However, if you have ever had any of the conditions listed on the form (for example, high blood pressure), then you must undergo a complete medical examination by an appointed examiner. The category4 MC is restricted to use with gliders, ultralights, recreational pilot permits and student pilot permits (aeroplane).

All professional pilots (commercial and airline transport) require a category1 MC, air traffic controllers and flight engineers require category1 or 2 MC, and private pilots and balloon pilots require either category1 or 3 MC to validate their licences. Examinations are required as frequently as every six months, for professional pilots who are at least 40years of age, or as seldom as every five years, for private or balloon pilots who are under 40. The validity periods are printed in a table on the back of the MC. Appointed physicians are known as Civil Aviation Medical Examiners (CAME), and there are about 900 of them in Canada and overseas. A list on our Web site (http://www.tc.gc.ca/eng/civilaviation/opssvs/cam-menu.htm
can be searched by country, province or city.

When you arrive at the CAME's office, you will first complete PartA of the medical examination report (MER), where identification data is recorded. If this is your first visit to a particular CAME, you will probably be asked to show proof of identity in the form of photo ID. In addition to your identification, you should bring with you copies of any prescriptions (or the medications themselves), and a copy of your lens prescription if you require glasses or contacts. If you have had medical treatment since your last examination, then the name and phone number of your personal physician will facilitate getting copies of any records or reports that may be required.

When filling out the form, it is important to record your permit/licence number if you have previously applied for a MC, as well as the type of licence or permit desired and/or held, since this will determine which category is appropriate for your needs. The desired type should be consistent with your choice of primary type of flying intended (recreation, business or career), as confirmed later on the form.

Your daytime telephone number (and fax or e-mail if preferred), along with your current postal address in full, are required so that we can reach you promptly if we need to obtain further information. A tick-off box for address changes is provided so that Transport Canada records can be updated if you have moved since your last examination. You should write your complete legal names (rather than just initials and nicknames) as they appear on your passport or other identification. Your country of citizenship and birth date are requested for compliance with international agreements.

If you are a pilot, then the record of pilot flight time can be helpful if we need to apply flexibility, or when any medical limitation or restriction is considered. The identification of any aircraft accident is also important since this information is not routinely available from safety data and it may require special attention if it was associated with either a medical cause or resultant injury.

Similarly, a positive answer to questions regarding prior medical unfitness (being refused issue of an MC) or receiving a medical pension may lead to a request to document the condition before a certificate can be issued or renewed. Although a prior refusal to grant an MC may be considered as a red flag, you should be reassured that we will base our assessment only on your current condition and prognosis (expected outcome). We will apply up-to-date standards (which tend to be more liberal), using flexibility where possible. Many pilots and controllers who were previously found to be unfit would be acceptable by the current rules.

One of the most important, but often overlooked, questions in PartA is: "Have you consulted a physician since your last aviation medical examination? If yes, give reason." It is in your interest to ensure that the CAME is aware of any other examinations, tests, diagnoses or treatments that you have undergone or received, both to prevent duplication and prevent embarrassment (if information is omitted here but revealed later in the assessment process).

Finally, you should indicate the dates of previous MERs, audiograms or electrocardiograms (ECGs) submitted for licensing purposes, and indicate the official language in which you prefer to receive correspondence.

PartB of the MER consists of a medical history and review of systems. The examiner should complete this part, but it also requires your input. A section on family history is included to identify persons at higher risk for genetic or familial diseases. There is also a block to record cardiovascular risk factors. Further investigation may be advised if you appear to be at increased risk for any of these conditions.

A thorough functional inquiry (review of systems) is the basis for any good medical examination. If there is any significant history or symptom, the details must be elaborated either on the form or on an attached sheet. If you have had an injury or illness, but have recovered without any disability that would affect flight safety, then the requested documents will easily confirm your aviation status.

One of the most important questions in PartB refers to current medications [prescription or over the counter (OTC)]. Few medications are completely prohibited in aviation, but it is important for us to know what a pilot or air traffic controller may be using in order to advise them professionally. You may be told to avoid certain drugs for some time before duty, or to use alternatives with fewer adverse side effects. In other cases, the examiner may defer your renewal until the case has been referred to our office (we will discuss the use of medications further in an upcoming issue).

After completing the review of systems (or perhaps at the end of the examination), you will read, date and sign the statement of applicant. This is a legal declaration that must be witnessed. You are reminded that it is an offence under the Aeronautics Act to knowingly make a false declaration. The continued success of our medical assessment system relies on your honesty and candour as an applicant.

The next part of the process (PartC) is the physical examination done by the physician, although other office staff may perform some measurements such as height, weight and blood pressure. There is a place on the MER form to record surgical scars, tattoos or other marks, since these may occasionally be useful for identification following aircraft accidents. Special examination is made of the visual and auditory systems because of their importance in the safe operation or control of an aircraft. Another routine test is that of colour perception - usually tested with colour plates or with a vision-testing machine. If your distant or near vision is not fully corrected, your ocular muscle balance appears to exceed normal limits, or you fail the colour plate test, then you may be referred to an eye specialist for correction or further examination (the topic of visual standards will be covered fully in an upcoming issue). Normally, hearing may simply be tested using whispered voice or a screening audioscope, but if there is evidence of decreased hearing, you may need to be tested with an audiometer to obtain a pure tone audiogram. Professional aircrew are routinely required to submit an audiogram on initial examination, and again after age55.

When you visit the medical examiner

The rest of the physical examination, although comprehensive, will normally confirm what is known from your medical history and review of systems. Even applicants who have had an amputation of a limb, or have some other physical disability, may be considered fit (for certain types of permits or licences) through the application of flexibility. Before issue of an MC, a practical flight test may be required so that the applicant may demonstrate the ability to compensate for the physical deficiency and safely pilot or control an aircraft.

If you are a private pilot over 40years of age, you will need to submit an ECG at least every five years (professional aircrew need to do so more frequently, and earlier). The only other requirement during the examination is for a urine test, which can be done in the examiner's office.

When the examination has been completed, the CAME will make a recommendation of fitness on the form and forward the documentation to the Regional Aviation Medical Officer (RAMO) for review. If the examiner considers you to be fit, and if you already hold an MC, then the CAME may renew your MC for the full validity period. This is done by stamping, signing and dating one of the renewal boxes on the back of the MC. However, CAMEs are not permitted to issue initial certificates, alter restrictions or upgrade categories.

If you are a new applicant, or if there is doubt whether you still meet the medical standards, then the CAME will defer issue or renewal. In that case, the RAMO will contact you to request further information (and perhaps other medical investigations) before completing your assessment.

In the unlikely event that the examiner considers you unfit to fly or control an aircraft because of a medical condition or treatment, they are obliged to inform Transport Canada (as all physicians and optometrists in Canada must do in accordance with the Aeronautics Act). If you already held a certificate, you would be prohibited from exercising the privileges of your permit or licence in accordance with Canadian Aviation Regulation (CAR) 404.06.

If, for any reason, the CAME cannot renew your certificate, then your assessment will be completed by the RAMO. Once this is successful, you will be issued a new MC. Any restriction, such as "valid only when wearing required glasses," will be printed on the new certificate. Between 50000 and 60000MERs are submitted annually, and the vast majority (over 98%) are assessed as either fit or fit with restrictions.

If you have any questions regarding your personal medical fitness, they should be directed to either your CAME or RAMO. Toll-free numbers for the Regional medical offices are printed on the tear-off bottom section of the MC, as well as published on our Web site (under Contacts).

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