Claude Preitner FRNZCGP FACASM

Transcription

1 GP CME 2014 workshop Claude Preitner FRNZCGP FACASM Senior Medial Officer Civil Aviation Authority

2 Senior Medical Officer with CAA No financial interest in any of my presentations Picture: Glass Cockpit - Cessna 4 seats

3 General Aviation Aircraft CAA Private Pilot licence Class 2 CAA medical certificate GPs obligations to report changes in medical conditions suspected to affect flight safety

4 (s27c Civil Aviation Act) If reasonable grounds to suspect a pilot may be unable to.exercise safely privileges Must inform the Director (i.e. the CAA doctors) and the pilot of doing so Low threshold (suspect.may be) Indemnified Act

5 Incapacitation Impairment of functional capacity Impairment of cognitive function: medication drug / alcohol organic brain disease sleep apnoea Behaviour Mental health dangerous act drug / alcohol

6 Recreational Pilot licence (RPL) Licence issued by CAA Your average small Cessna / Piper / LSA 1 Passenger only No night flying / no instrument flying / no aerobatics Commercial Driving Medical Certificate Class 2 or above with P endorsement - by GP DL9 form medical practitioners to consider medical aspects of fitness to drive when conducting a medical examination to determine if an individual is fit to drive. GP responsibilities: Certify in accordance with guidelines

7 Under some circumstances, a licence may be granted with conditions to existing holders of these classes and/or endorsement types. If there has been a full and complete recovery with no suggestion of recurrence over a period of three years, the possibility of a return to driving may be considered by the Agency (via the Chief Medical Adviser). A supporting specialist physician or neurologist s report will be required.

8 Acute uncomplicated myocardial infarction Should not drive for at least four weeks. Return to driving subject to specialist assessment. Coronary artery bypass surgery Should not drive for at least three months. Return to driving subject to specialist assessment.

9 Microlight Self regulating organisations Civil Aviation Rules - Part 149 Gliding Hang-glider pilot Parachuting Balloon

10 Medical Declaration Long flights Dehydration Hypoxia Bends Medical Advisor: Dr David Powell com

11 Weight < 600 kg 2 seats max Stall speed <45 Kts No flight over congested areas Some have balistic parachutes Medical advisors Dr Hugh Tapper, Invercargill - RAANZ Dr. Krishnen Pillay, Cambridge SAC

12 Medical Declaration (a) Epilepsy and other periodic disturbances of consciousness, giddiness, history of severe head injury. (b) Diabetes, requiring insulin therapy. (c) High blood pressure, coronary artery disease. (d) A history of alcoholism or drug addiction. (e) Psychiatric disorder.

13 Medical Declaration for new participants None for certificated sky divers Class 2 CAA certificate for tandem masters

14

15 Hang Gliding and Paragliding Association

16 Several accidents in recreational aviation with fair paying passengers Hang-glider accident Masterton Balloon accident CAA has responded by certifying adventure aviation (Part 115 of the Civil aviation Rules)

17 The Professional Association of Scuba Instructors (PADI ) Physician s Impression I find no medical conditions that I consider incompatible with diving. I am unable to recommend this individual for diving. Remarks

18 incapacitation Cardiovascular Asthma / emphyzema / pneumothorax Eustachian tube / sinus Neurological i.e. seizures Poor physical fitness Functional capacity Back / limbs / vision CV fitness Cognitive function Medication / alcohol / drugs Nitrogen Narcosis Behaviour

19 Functional ability to do the task No condition that could be made worst by the activity / (unless risk mitigation can be implemented) No condition that may put others at risk

20 Condition being treated Medication Pain Sleep, mood, distraction Depression ENT Skin Respiratory Cardiac Cancer Side effects Cognitive / mentation Vision: i.e anticholinergic, isotretinoin Risk of incapacitation Anticoagulants Increase risk of seizure QTc prolongation

21 Depression in full sustained remission ~ 3 months Medication acceptable Fluoxetine acceptable Citalopram acceptable Sertraline acceptable Venlafaxin less/not acceptable Aropax less/not acceptable TCA generally not acceptable Multiple medication generally not acceptable Case by case assessment by CAA

22 Chronic pain Severity of condition Functional capacity ADL? i.e. sitting tolerance Sleep? Mood / Frustration? Distraction Medication Cognitive function? Impairment / Incapacitation i.e No opioids, no anti-epileptics

23 No flying while in pain No flying on Prednisone until: Dose reduced to below 10 mg per day Condition

24 No flying for one month Return if no significant side effects, mood alteration etc. Night flying restriction until one month after cessation All this administered by CAA

25 Cardiovascular CAD, Tachyarrhythmia (AF), Vasovagal syncope etc. Neurological Migraine Stroke Epilepsy Transient Global Amnesia sheets.htm

26 Metabolic / Endocrine Diabetes on insulin or sulfonylurea Other incapacitating conditions Crohn, Ulcerative colitis, Cholelithiasis Renal lithiasis Unstable Asthma COPD

27 Absence of side effects: Period of observation on the ground Implement the change when the pilot is able to have down time i.e. increasing BP treatment or Metformin Introduction of an ACE inhibitor

28 Request to provide regular information: GP report i.e. every 3 months Biochemistry / blood count Psychiatrist report Psychologist report Drug and Alcohol counsellor report Oncologist report Cardiologist report.etc

29 Mr X was seen today, he is well and continues to be fit to fly Mr X was seen today. He is in good spirit, he reports sleeping well and having no problem with concentration. He has resumed and enjoys sailing. He continues taking Fluoxetine 20 mg per day. He takes no other medication. On examination..or, Write your notes in some details and give a copy to your patient See NZMC guidelines on reporting to third parties.

30 GPs have an important safety role when certifying patients for any recreational activity (flying, diving) Certify according to the applicable guidelines Inform your patient of their risk of impairment or incapacitation I concern report to CAA Stay factual, advocating may put the patient at risk CAA and relevant Flying Organisations medical advisers can give assistance when in doubt

31 Condition may be limiting factor Medication / treatment may be limiting factor Ethical dilemma Best treatment for the condition? or Lesser but acceptable treatment for certification? Duty to inform CAA aviation medicine team med@caa.govt.nz

32 Please share your experience