by Dr. John Beasley, M.D.
Aviation Medical Examiner
Professor Emeritus and Clinical Professor
Department of Family Medicine University of Wisconsin – Madison
Driving up to EAA AirVenture Oshkosh this year, I’m in a Honda CRV. Passing Rosendale, Wisconsin (the nationally-known speed trap on Highway 26), I’m doing 55 on a two-lane highway. I have less than 10 feet of clearance between my CRV (empty weight 3426 pounds) and whatever vehicle is oncoming. We have a combined closing speed of 110 mph, assuming he or she is also going 55 mph. Traffic is heavy. If I’m not competent to drive or if I black out, the consequences could be severe.
While I have a Third Class Medical in my pocket, what makes this death defying drive legal is my driver’s license. When I got my driver’s license renewed, I had to demonstrate that I could successfully find the driver’s license station, open the door, stumble to the counter, and pass the vision test. So, all in all, not a very demanding examination. But the system still works.
Society assumes that I’ll use reasonable judgment and not endanger others if I am not able to drive safely. And, really, the same is true of our Aviation Medical Examination. If you walk out of my door after an exam, with the ink not yet dry on your medical certificate, and you come down with influenza, it is up to you not to fly until you have recovered.
Given this reality, it has been argued, and to me convincingly, that doing Class III medical exams is most often a waste of my time and your money, and adds little to safety. Pilots are self-certifying every time they get into the left front seat. That said, when I do exams and issue certificates, I feel compelled to “play by the rules,” and I feel that when questions come up about “Am I safe to fly?” that I have some expertise in giving you a realistic answer. Plus, I love chatting with fellow pilots, many of whom are my friends.
There are really two considerations in issuing a medical certificate: 1) Can this pilot perform satisfactorily the duties of pilot in command? That is, does this person have the sensory, motor and psychological capacity to do what needs to be done? 2) The other consideration is (and this is a bit trickier), might this person be subject to sudden incapacitation?
Here, we try to evaluate the risk of heart attacks, seizures and the like. I’m currently trying to get a person with kidney stones through the system. If you have ever had one cause urinary obstruction, you know that they are painful to the point of being incapacitating and could certainly screw up a final approach, so there is some risk.
Regarding sudden incapacitation, there is one obvious difference between flying and driving which is that usually if somebody has sudden incapacitation while driving, it probably won’t be so sudden as to not allow them to at least pull over and stop the car. In any case, the fact remains that we are horribly bad when it comes to predicting sudden incapacitation, whether for pilots or drivers.
Here is the rationale to understanding risk.
In engineering, there is a way to evaluate hazards by considering both the possible frequency of an event and the severity of potential consequences. One nice link for more on this is: http://en.wikipedia.org/wiki/Hazard_analysis.
Obviously, we worry more about situations where both the likelihood of an event and the severity of the consequences are high. We tolerate the possibility of very high severity events if the likelihood is very low. (Think of nuclear power plants, at least prior to Fukushima), or low severity events with higher likelihood. (Think of trying to land in a bad crosswind, where at worst, you’ll probably help your mechanic finance his boat.)
The FAA does some reasonable hazard analysis, and accepted that the likelihood of a light sport aircraft having an accident due to a medical issue, is low, as is the potential severity (most likely involving only the pilot and his/her passenger), so the overall hazard is low. I commend the FAA for making a good start at this issue by allowing the driver’s license certification for light sport aircraft operations. Both the likelihood and the potential severity are low.
For my patient with the kidney stones, the potential severity is not terribly high even though the incapacitation could be severe. But the probability that this will happen while he is actually flying a plane, is vanishingly low. So the overall risk is quite low.
Other countries are ahead of us.
In June 2012, the Australian Civil Aviation Safety Authority decided to allow pilots to use a slightly modified driver’s license certificate based on a “modified driver licence medical examination” that can be done by any physician. (They spell “license” differently down there, so that isn’t a typo.) See: http://www.casa.gov.au/SCRIPTS/NC.DLL?WCMS:STANDARD::pc=PC_100908.
You will need a driver license medical certificate (aviation) confirming your fitness to fly, issued in accordance with the conditions in Instrument CASA EX 68/12. When applying for this medical, you must tell the doctor of any condition that may adversely affect your ability to fly safely. Examples include, but are not limited to diabetes, epilepsy, heart conditions, stroke, eye problems (such as cataracts), psychiatric disorders, blackouts or fainting. If you get your “Driver Licence Medical Certificate,” you are good to go at what would be in the U.S., a Class III level. Obviously, it will be some years before we see the impact (no pun intended) of this on aviation, but they should be getting some good data. We already have very reassuring results from the Sport Pilot experience here.
I do hope that the FAA will elect to extend policy to aviation activities requiring a third-class medical certificate in the U.S. I might see my flying friends a bit less often in my office, but that’s okay.
And, oh yes, I am a member of the American Medical Association (AMA), which at their June 2014 annual meeting, decided to oppose any change in the rule, to my displeasure.
BTW, I got that guy with the renal stones certified. The system works, but it could be easier.
