The Dreaded Aviation Medical

September 27, 2007
Written by Dr. Tarek. M. Sardana

Is it that time of year again, is it time for your ‘dreaded’ aviation medical with your friendly Civil Aviation Medicine Examiner (CAME), an event that is akin to a root canal in the dental world! Well, this article will hopefully shed some light on this event and allay any fears or concerns that pilots may have toward their aviation medical examination.

This case is loosely based on a true story, I have changed the specifics to comply with patient confidentiality but the message is evident.

This patient is a senior pilot with a small British Columbia helicopter logging company. He is 47 years old and has about 4,000 total flying hours. He is about 40 pounds overweight, has slightly elevated cholesterol and he has the occasional cigaret and beer. Due to his hectic schedule he does not exercise. (Does this sound like anyone you know?) Over the past eight months he complains to a close co-worker that he has the odd twinge of chest pain with numbness going into his left arm lasting up to an hour. The co-worker encourages the pilot to see his family doctor/CAME but the patient refuses as “he doesn’t want to lose his licence.” (Does this sound like anyone you know?) The patient continues on with his usual dedicated manner, moving timber around the mountains. He sees his CAME for his regularly scheduled aviation medical during one of his scheduled weeks off, but he does not disclose his chest complaints as he doesn’t want to go through the hassle of all the tests and is still worried that Transport Canada will ‘pull his ticket’.

Unfortunately, not too long after his medical, the pilot collapses while doing some yard work at home on one of his days off. His wife calls 911 and the pilot is rushed off to the ER but is pronounced dead from a large myocardial infarction (heart attack). He leaves behind his wife and two teenage children.

This case illustrates the worstcase scenario of denial and withholding of medical information. Had this pilot been forthcoming right from the start, he may still be with us today.

Let’s look at the Aeronautics Act of 1985, which I will summarize (i.e., take out the legal jargon) below: Aeronautics Act (1985) - Medical and Optometric Information

6.5 (1) This section states that if your CAME or any physician thinks that you may have a condition that is likely to constitute a flight safety hazard, then he/she must inform the designated medical authorities at Transport Canada.

(2) This section states that as a holder of an aviation licence, you must inform all of your health care providers (not just your CAME) that you are a pilot at every physician contact.

(5) This section states that the information that either you or your health care provider provides to Transport Canada is not subject to any legal or disciplinary hearings. In fact this information shall not be used in any proceedings.

(6) This section states that as a holder of an aviation licence you agree to follow the Aeronautics Act. You don’t have to sign anything, just the fact that you hold a certificate is all that is required; therefore, stating that you were not aware that these were the rules won’t cover you legally should an accident/incident occur.

In a nutshell, the Aeronautics Act states that with any medical contact a pilot is to disclose that he is an aviator and not doing so is actually a violation of the law. More importantly, not disclosing may have disastrous results on a more personal level as illustrated in the case report. Why are pilots/aircrew afraid to disclose information to their health care providers? This is a very complicated topic but there are some general explanations for this phenomenon. Pilots and physicians are very much alike from a personality makeup perspective; typically, pilots are often Type A personalities in that they are leaders and decision makers. In general, pilots (and physicians alike) are problem solvers and we will often try to minimize symptoms or more likely, rationalize them or solve the issue with our own coping mechanisms. Pilots have a great capacity to compartmentalize their lives and when a medical issue arises they have a strong tendency to deny it exists and then place it in a compartment and essentially not worry about it. This behaviour actually makes good pilots; from an aviation safety perspective, you want a pilot to be able to push away life’s little annoyances when they are in command of an aircraft. Unfortunately, this behaviour also makes most pilots (and physicians) very poor patients (does this sound like anyone you know?). It is imperative for anyone experiencing a potentially significant health issue to overcome their natural tendency to dismiss their symptoms and consciously make an attempt to discuss their concerns with their physician.

So, why do we actually do aviation medicals? The primary reason is to ensure the safety of the aviation system and the flying public. Also, we want to ensure that the pilot is fit from an individual perspective and is not going to become suddenly incapacitated. This is the bottom line, as CAMEs we are concerned with medical conditions that may result in sudden incapacitation. Obviously, a rash on your leg will not result in you suddenly collapsing and causing a critical flight safety incident, but chest tightness may lead to a heart attack which may cause a sudden incapacitating event. Airline pilots have had heart attacks while flying and I specifically recall a British Airways captain who died while flying from London to Tokyo; his first officer safely completed the flight. These cases, although few and far between, do in fact occur. These are the type of issues we are looking for when we conduct the medical.

The “1% Rule” is a general guideline (not official policy) as the line in the got to use a 727-200, 757 or Airbus configured for 50-60 businesspeople. The trouble is that these larger aircraft are expensive; you don’t hold the price down just because these planes have been configured to only hold 50 seats.”

Today, Canada’s fixed-wing charters rely on prop planes. They have to; in most cases, comparable jet transports are just too expensive to buy and maintain. However, this may soon change as VLJs (Very Light Jets) make their presence known in the aviation world. Built to have a maximum takeoff weight under 10,000 pounds, they can seat between three and six passengers. VLJs are meant to compete with prop planes on purchase, operational and maintenance costs.

Among the VLJs that are available now or coming to market soon are the Eclipse 500, Cessna Citation Mustang, the Adam A700 AdamJet, and Diamond Aircraft Industries’ D-JET. Meanwhile, if you’re a charter operator who wants to sell your passengers a thrilling ride, get an ATG Javelin Mk.10. Powered by a pair of Williams FJ33 turbofans, the two-seat ATG Javelin looks like a T-38 jet trainer with an F18’s twin tail, thanks to the Javelin’s seat-behind-seat cockpit arrangement, fighterstyle fuselage and clear fighterstyle canopy.

“We see ourselves moving into VLJs,” says Dylan Fast. “We still have yet to have one certified in Canada, but eventually that will come.”

“When they get VLJs into service, it will be tremendous for the air charter business,” enthuses Larry Libman. “Compared to conventional business jets, they cost 50 per cent less to buy and operate. This should result in us being able to offer a 35-40 per cent lower ticket price for flights from Montreal to Toronto, New York and Chicago. This should increase our closing rate by at least 50 per cent.”

Does this mean that VLJs are the ‘Next Big Thing’, as far as fixed-wing charters are concerned? On this point, operators disagree.

“If the VLJs do what their makers say they’ll do, they’ll obsolete the Navajos and the KingAirs,” adds Adam Penner. “People like jets, while prop planes are looked down upon. Plus, the VLJs should go twice as fast and twice as high as props, and be far more comfortable to fly in.”

“I don’t think they’ll put props out of business,” counters Fast. “Yes, VLJs will fill a niche market for two to four passengers. But we are still doing a lot of flights up north where we’re carrying seven to eight passengers. The VLJs can’t replace the props that carry them, but I can see them creating a new market.”

Even with the challenges that they face, it is clear that Canada’s fixed-wing charter operators are well positioned to profit in the years ahead. As commercial airline service declines in quality and coverage, charters are a natural alternative for first-class travellers, and those business passengers who are fed up and willing to pay more for a better travelling experience.

Meanwhile, the advent of VLJs will make jet aircraft more affordable and accessible for air charter operators, allowing them to offer an enhanced level of service at prices customers should be willing to pay. Put it all together, and it’s a good time to be in the fixed-wing charter business – especially if you can justify buying a fighter-like ATG Javelin Mk.10 for your company!

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