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					               A EROMEDICAL K I T

This Medical Kit

General Discussion:
    • 8 Principles of
      Problem Aeromedical
    • Sources of

•       Hypertension

•       Hypertension
                            T      his guide has been prepared to assist the
                            pilot with hypertension in obtaining airman
                            medical certification. It is accompanied by a
                            checklist, which the airman can use to insure
Prepared by EAA
                            that all requested data has been obtained.
Advisory Program
                             Page 1 of 8 Pages
                               EAA Aeromedical Advisory Program

Purpose of the Aeromedical Advisory Program

EAA is committed to keeping our members flying. When you develop a medical condition that might com-
promise your ability to obtain, maintain, or regain airman medical certification, the first thing you must do is
to become knowledgeable about the condition and how it might affect airman medical certification. EAA
has developed the Aeromedical Advisory Program to assist you with problem medical certification. You
should avail yourself of any and all information that will provide knowledge of the condition in question.

Consultation on Your Condition

EAA Pilot Advocates are Aviation Medical Examiners (AME) who volunteer to help other EAA members
with medical certification. Pilot Advocates are knowledgeable in aviation medical certification issues and
will make sure you have the proper medical information necessary for a certification exam. The Pilot Advo-
cate provides assistance such as phone consultations, record review and support of your request to the Fed-
eral Aviation Administration (FAA). The Advocate assists you in the proper preparation of FAA paperwork
and, if necessary, calls appropriate resources within FAA. You may also choose to visit the Pilot Advocate
for the actual FAA medical exam at your own expense.

Referral to a Pilot Advocate:

EAA has a force of over 150 Pilot Advocates who are Aviation Medical Examiners (AME’s) tha t volunteer
their services in assisting members with problem aeromedical certification. These advisors are available for
consultation. To find a Pilot Advocate in your area, search under the EAA Member Only website or contact
EAA Aviation Information Services at 888-EAAINFO Ext. 6112.

Aeromedical Issue Kits:

EAA Pilot Advocates have prepared information packages, entitled EAA Aeromedical Issue Kits, dealing
with specific medical conditions, such as hypertension (Hypertension will be used as an example).
Aeromedical Issue Kits include :

8 Principles of Problem Aeromedical Certification: This is a discussion of general rules to be followed when an
aviator develops a medical condition.

Condition specific narrative: This is a narrative discussion in paragraph form outlining FAA certification requir e-
ments for a specific medical condition, such as hypertension.

Condition specific checklist: This checklist provides check boxes to make sure that all requested FAA requirements
have been provided. The checklist format ensures that one or two missing items (empty boxes) will not cause lengthy
delays in the certification process.

Please review the Aeromedical Issue Kit applicable to your condition prior to contacting a Pilot Advocate.

                                           Page 2 of 8 Pages
                     By John Hastings, M.D. (November 2003)

The following principles have been developed from the experience of Aviation Medical Examiners (AME’s)
who for many years have dealt with problem aeromedical certification issues. All too often the aviator who
develops a medical condition does not have the knowledge and does not know where to obtain the knowl-
edge that will provide a guide towards timely certification. The FAA medical certification system is over-
burdened, and accommodative change will take funding and time. When an aviator develops a medical
problem which might compromise medical certification, he or she must provide as complete a package as
possible for submission to the FAA. This can avoid lengthy delays in the certification process. You, the
pilot, must spearhead the process. Since most AME’s perform a limited number of examinations annually,
most often on healthy aviators, experience with problem medical certification is limited. By educating your-
self, you gain an understanding of the process and help your AME or an Aeromedical Advisor in obtaining
or regaining certification.


1. Something has changed: If a change has occurred since your last airman physical, assume the FAA
   will show an interest. If you have to answer "yes" or report a new condition, expect questions. Antici-
   pate the FAA's questions. Remember, they are looking at a paper record in search of conditions that
   might compromise aviation safety. Obtain the records that explain the situation before you see your
   AME for your flight physical. Call your AME for guidance as to what information is necessary. If you
   have doubts about your condition or know that the condition is disqualifying and will require special
   issuance, contact the EAA Aeromedical Assistance Program for advice before your examination. Often
   it is possible to appear for your exam with all the records needed for a decision. At times on-the-spot
   certification is possible if information is sufficient. This may or may not require phone consultation
   with the regional flight surgeon or Aerospace Medical Certification Division in Oklahoma City. If on-
   the-spot certification is not possible and deferral to Oklahoma City is necessary, processing of the appli-
   cation will occur in a much more timely fashion.

 2. Educate yourself about your condition: 80% of the AME’s in the country do about 15 or so examina-
    tions per year, a fact not commonly known among pilots. Therefore, your AME may not have experi-
    ence with problem aeromedical certification. You must seek the information that will give you the
    knowledge to deal with your AME and the FAA medical certification system. Use the sources of info r-
    mation that are provided in the EAA Aeromedical Kit pertaining to your condition.

 3. Responsibility: The one person with the greatest interest in your securing medical certification is you,
    the pilot. Your primary care physician, specialist and AME may be sympathetic and willing to help, but
    you alone can keep the process moving and ensure all necessary information is gathered. Non-pilots
    may have difficulty understanding what it means to be grounded. They are used to routine requests and
    don't understand your urgency. Don't delegate record gathering to others unless you are willing to accept
    frustrating delays.

                                        Page 3 of 8 Pages
Continuation of Eight Principles Problem Aeromedical Certification

4. Documentation: The most common cause of certification delay or denial is lack of documentation. This
    simply means the FAA has insufficient information on which to base a decision. This leads to repeated
    cycles of correspondence with the FAA, each consuming months of precious time. The pilot may not
    know what information must be gathered; your attending physician and consulting specialist are seldom
    familiar with the aeromedical certification process. Your AME may be unfamiliar with problem cases.
    With documentation, your AME may be able to obtain on-the-spot certification, or can send a complete
    package to Airman Certification Division. Call the EAA Aeromedical Advisory Program for assistance.

5. Record Gathering : The FAA may want emergency room notes, ambulance records, history and phys i-
    cals, laboratory studies, X-ray and imaging studies such as CT scans, EKG's, EEG's and MRI scans. At
    times reports of procedures will suffice, and at times the actual studies are requested. Read carefully the
    FAA request for information, and be diligent in obtaining the information. This is all part of documenta-
    tion. Use the information sheets and checklists available in the Aeromedical Advisory Program when
    applicable. Your AME may possess previously gathered needed information.

6. Flying Fitness Decisions : Your primary care physician or the specialist you see for a condition does not
    have authority to say you are "fit to fly." Most are not familiar with FAA aeromedical standards. Your
    AME or the FAA must decide how your individual situation might affect aviation safety. Fitness to fly
    is an aeromedical decisio n that cannot be delegated to others. It is helpful to have all consultants state in
    their letters (if they can) that you are "no more likely to be suddenly incapacitated by your condition
    than anyone in the general population."

7. Single Package Planning : Presently the FAA certification system is paper-based, though conversion to
    an electronic record is well under way. If your AME sends in your physical, followed by additional
    information that trickles in over weeks or months, lengthy delays will result while information finds its
    way to your record. Frustrating delays can be avoided by assembling a complete package of information
    to be sent in with your airman physical. Send by express delivery to assure arrival and to obtain a re-
    ceipt signature.

8. Use the EAA Aeromedical Advisory Program: Contact Information Services if you have a problem or
    anticipate a problem. Information is available that can help you, your primary care physician, your con-
    sulting specialist and often your AME who seldom encounters problem cases and may not know what
    you need. This program is dedicated to you and your certification.

                                            Page 4 of 8 Pages
The following information must be provided to fulfill all FAA requirements. A checklist form is
also included.

1. An airman who has come under treatment for hypertension since his last airman medical examination,
   or whose blood pressure is above acceptable limits when examined by the AME will not be granted a
   medical certificate without further study. For example, reporting new use of blood pressure medication
   in Item 17 (medication history) on the FAA form will trigger further study (see below).

2. Your Aviation Medical Examiner (AME) records your blood pressure in the seated position. If it is
   high (generally above 155/95) but normal when taken lying down, all classes of medical certificate
   may be granted. Your AME should note adverse factors that might influence blood pressure readings,
   such as hurry, fear or anxiety.

3. If you had been treated, but have been off medication for 30 days and now have normal blood pres-
   sure, your AME can issue a certificate. This might occur with a weight loss program or smoking cessa-

4. If your blood pressure remains high, despite relaxation and lying down, your AME can ask for a series
   of blood pressure readings consisting of three morning and evening blood pressure readings over 7
   days. If normal, a certificate may be issued. If values remain high, your AME must defer certification.

5. Your AME must defer if your hypertension has not been evaluated, if you are taking unacceptable
   blood pressure medication, if your medical status is unclear, if your blood pressure is uncontrolled or if
   a decision about special issuance has been reserved for the FAA at headquarters.

6. If you have treated hypertension since your last airman exam, your AME may issue a medical certifi-
   cate if (at the applicants option) a current (within 6 months) cardiovascular evaluation is provided
   which shall include the following:

   ·   Personal medical history
   ·   Family history
   ·   Recording of cardiovascular risk factors (smoking, weight, etc.)
   ·   Clinical examination with at least 3 blood pressure readings
   ·   Resting electrocardiogram
   ·   Fasting plasma glucose
   ·   Cholesterol with HDL and LDL determinations
   ·   Triglycerides
   ·   Serum potassium determination
   ·   Cardiac stress test if indicated by history or clinical findings
   ·   Specific mention of medications, dosages and the presence or absence of side effects or history of
       adverse effects

                                       Page 5 of 8 Pages
Your AME should summarize the results and attach the data to your airman medical applica-
tion and report any additional tests. The AME should state that your blood pressure is controlled on
an acceptable medication, that significant adverse effects are not present, and that no significant
cerebrovascular or atherosclerotic disease is evident.

If an airman declines such an evaluation, certification must be deferred.

1. Medications: Medications acceptable to the FAA include all FDA approved medications in-
   cluding diuretics, alpha-adrenergic blocking agents, beta-adrenergic blocking agents, calcium
   channel blockers, angiotensin-converting enzyme (ACE) inhibitors and direct vasodilators.
   Centrally acting agents (having affects on the central nervous system) such as reserpine,
   quanethidene, guanidrel, guanibenz and me htyldopa are not acceptable to the FAA because of
   potential side-effects. An airman taking such agents might ask for special issuance, though this
   will likely require specialty evaluation.

2. Follow-Up Reporting: Annual follow up is required for Class I and II certificates. Routine
   intervals are used for Class III certificates. The following information is required:
     · a current status report from your treating physician
     · medications and doses
     · statement regarding blood pressure control
     · freedom from significant side-effects of treatment
     · laboratory results
     · freedom from significant end-organ disease, such as stroke or kidney failure
     · The medical certificate shall be valid until its normal expiration date provided that required
         reports are forwarded to the FAA.

j    These pilot guidelines should assist you in obtaining airman medical certification. Use
    the checklist enclosed to insure that all requested information is provided. This will avoid
    further delay. If possible, assemble all information before your visit to the AME.

    EAA Aeromedical Advisory Council

                                  Page 6 of 8 Pages
                 Checklist for Hypertension

Hypertension: Initial Evaluation

A current (within 6 months) cardiovascular evaluation from your primary care
or treating physician, which must include:

 c   Personal medical history
 c   Family history
 c   Recording of cardiovascular risk factors (smoking, weight, etc.)
 c   Clinical examination with at least 3 blood pressure readings
 c   Resting electrocardiogram
 c   Fasting plasma glucose
 c   Cholesterol with HDL and LDL determinations
 c   Triglycerides
 c   Serum potassium determination
 c   Cardiac stress test if indicated by history or clinical findings
 c   Specific mention of medications, dosage, and the presence or absence of
     side effects or history of adverse effects

Hypertension: Follow-up

Follow-Up Reporting: Annual follow up is required for Class I and II certifi-
cates. Routine intervals are used for Class III certificates. The following infor-
mation is required:

 c   A current status report from your treating physician
 c   Medications and doses
 c   Statement regarding blood pressure control
 c   Statement of freedom from significant side-effects of treatment
 c   Laboratory results
 c   Freedom from significant end-organ disease, such as stroke or kidney

                            Page 7 of 8 Pages
                                          Aeromedical Resources

EAA Aviation Information Services:
     Call the EAA Member line, 888-EAAINFO Ext. 6112, for personalized assistance.

EAA Website:
     Medical information is available on the website in the Members Only section. From the main page,
     log in as an EAA member. From there, select Medical Assistance.

Virtual Flight Surgeons Inc.:
       This site was developed and is maintained by aeromedical physicians who have worked with the Air-
       line Pilots Association (ALPA). There is a wealth of information that is offered at no charge, with
       much guidance about specific medical conditions. Additionally, fee for service individual consulta-
       tion services are available ranging from inexpensive answering of questions to more in depth ser-

Pilot Medical Solutions:
       Pilot Medical Solutions is run by David Hale. This is a fee for service based medical advisory ser-
       vice for pilots with problem aeromedical certification.

Office of Aerospace Medicine:
       This is the government website for the Office of Aerospace Medicine. Medical certification resides
       at CAMI, the Civil Aeromedical Institute. The site contains a directory of AME’s, information about
       special issuance certification, and other useful information.

                                        Page 8 of 8 Pages

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