AMEs Guide Includes Medical Certification Based on Latest Data
By ALPA Staff
The FAA’s Guide for Aviation Medical Examiners (AMEs), dated May 31, 2023, reflects the Office of Aerospace Medicine’s continued interest in updating pilot medical certification policies based on recent studies and as new information becomes available. Details of these recent changes were highlighted in May at the Aerospace Medical Association’s 93rd Annual Scientific Meeting, giving special attention to pilots who have one of six diagnoses that require further attention.
Among them, the FAA has expanded the options for pilots seeking medical certification while being treated with antidepressants. In addition to the four previously allowed selective-serotonin-reuptake-inhibitor medications—fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro)—the FAA added bupropion (Wellbutrin) as an acceptable treatment. Dr. Susan Northrup, the federal air surgeon, announced that several additional medications are being reviewed and could be considered acceptable in the future.
What distinguishes bupropion from other antidepressants is that it’s not typically associated with sleepiness or weight gain.
Northrup also announced that annual cognitive testing for those pilots renewing their AME-assisted special issuances (AASI) for medication-treated depression is no longer required. This step will streamline the recertification process and reduce waiting times for other psychological conditions being reviewed by the FAA.
Pilots who suffer from some degree of color blindness should be aware that there are three computer-based tests (with scoring criteria) to help determine medical certification eligibility—the City Occupational Color Assessment and Diagnosis, the Rabin Cone Test, and the Waggoner Computerized Color Vison Test. Passage of any one of these assessments is now acceptable in addition to the previously allowed manual tests.
Other health-issue policies addressed in the May 31 AMEs guide update include a new status summary, an expanded disposition table, and updated information for AASIs to address chronic obstructive pulmonary disease, which causes airflow blockage and breathing-related problems. There’s also an expanded disposition table for hypoparathyroidism, a rare endocrine disease in which the body produces low levels of parathyroid hormone, and another for Raynaud’s Disease, which limits blood flow to certain areas of the body in response to cold temperatures or stress.
As noted, AASI is the process that enables an examiner to reissue an airman medical certificate even though the pilot has a medical condition that’s normally disqualifying under 14 CFR Part 67. At the discretion of the federal air surgeon, special-issuance authorization can also be allowed under certain circumstances with appropriate documentation for a specified validity period.
Updates to the AMEs guide are posted the final Wednesday of each month.
To the north, the Transportation Safety Board (TSB) of Canada has been urging Transport Canada (TC) to improve its medical screenings process for pilots. This action was prompted after a 2021 incident involving a pilot who reportedly suffered an in-flight heart attack. The TSB reported that civil aviation medical examiners aren’t required to conduct blood lipid screening tests. Meanwhile, the board highlighted a report published in 2019, identifying a consensus of aviation cardiologists from around the globe who asserted that pilots over the age of 40 need to be screened for cardiological risk factors.
Since 2000, the TSB has investigated a total of eight incidents involving commercial pilots in which cardiovascular disease was identified as a risk or cause.
“The intent of the recommendation is for TC to come up with a means to ensure that civil aviation medical examiners have the most up-to-date guidance available,” said TSB spokesman Chris Krepski, who added that making enhancements to heart-health issues is just one example of how the system could be improved.
The TSB has further advocated for the creation of a Transport Canada framework to ensure that the Handbook for Civil Aviation Medical Examiners contains the most effective screening tools for evaluating medical conditions.
Learn More
ALPA pilots from both the U.S. and Canada may contact the Aviation Medical Advisory Service (ALPA’s Aeromedical Office) to confidentially speak to one of its aerospace medicine physicians about health and medical certification issues. The office hours are Monday–Friday 8:30 a.m. to 4:00 p.m., mountain time. Additional information is available on the AMAS website. These services are available to all ALPA members at no charge.
