Aeromedical Certification Current Issues Ian Blair Fries, M.D. - PowerPoint PPT Presentation

Aeromedical Certification Current Issues Ian Blair Fries, M.D. Lawyer-Pilot Bar Association Vero Beach, FL March 7 , 2019

Who I Am • A1A Aviation Medicine, Inc. • Vero Beach, Florida • HIMS designated Senior AME • Focus on Special Issuances • TBM 900. A1A Aviation Medicine, Inc.

Ambien • 24 hour wait before flying • 1 to 2 times a week A1A Aviation Medicine, Inc.

Pilots Only • Do you drink alcohol? • If you are a teetotaler. • If you are alcoholic and/or addict in recovery you are excused from the next section. A1A Aviation Medicine, Inc.

Traffic Stop • Police request Breathalyzer test –On what basis ? –Must you comply ? –Should you blow ? –What must you report to FAA ? A1A Aviation Medicine, Inc.

Why Monitor ? • Speedometer • Radar detector • Oximeter • Breathalyzer A1A Aviation Medicine, Inc.

Breathalyzer • BAC = Blood Alcohol Concentration • Legal Limit States and Canada is 0.08% • As of December 30, 2018 Utah’s BAC is 0.05 percent. • Commercial Drivers 0.04%. • Under 21 years zero tolerance. A1A Aviation Medicine, Inc.

Breathalyzer • Wait 15-20 minutes after last drink. • Breathalyzer warms up. • Take a breath and blow smoothly until hear a click. • Sample collected from alveolar air that has equilibrated with blood gases. A1A Aviation Medicine, Inc.

Questions • Police see dark headlights • Police stop pilot after paper cup is thrown out a window • Asks pilot driver to blow • Pilot agrees because he has carefully calculated his intake. A1A Aviation Medicine, Inc.

A1A Aviation Medicine, Inc.

Alcohol Facts • Beers 2% to 8% alcohol • Wine 5% to 20% alcohol • Vermouth 20% • Sake 17% to 20% • Gin, Vodka, Whiskey – 80 proof = 40% – 100 proof = 50% • What is a standard drink ? A1A Aviation Medicine, Inc.

Questions • Pilot Calculated < 0.08 BAC • Blew 0.11 and 0.13 BAC • Arrested for driving while intoxicated. A1A Aviation Medicine, Inc.

Alcohol Facts • We are poor judges of our level of intoxication. • The more we drink the worse our judgement. • Tables and calculations based on alcohol quantity, time since ingestion, body weight and sex are inaccurate. • A designated driver does not drink at all. • Consider a Breathalyzer. A1A Aviation Medicine, Inc.

Drinkology • FAA now fully investigates the FIRST driving while intoxicated event. – Motor Vehicle • Car, boat, snowmobile, golf cart, ATV • Past alcohol or drug use history • Abnormal liver function tests • Pancreatitis, hepatitis, GI bleeding • Cardiac arrhythmia “Holiday Heart” A1A Aviation Medicine, Inc.

DUI Facts • DUI driver has likely driven 80 times drunk before arrest – Sentinel event • One third of all DUI arrests are repeats. • 50% to 75% of convicted drunk drivers continue to drive without a license. • One out of three of us has been in an accident with alcohol involvement ! • 1 out of 20 pilots have had a DUI. • 1 out of 200 pilots have two or more DUIs. A1A Aviation Medicine, Inc.

Required Reports • Any motor vehicle violation/action involving alcohol or drugs requires a notification letter to FAA Security and Hazardous Materials Safety Office (AXE-700) within 60 days. • Report each action, even if due to same event. Counts as only one. • Arrest is not specifically addressed. A1A Aviation Medicine, Inc.

Required Reports • Report DUI on all subsequent MedXpress applications. This includes arrests. • Both Security and MedXpress reports are required. – Reporting to an AME within 60 days does not substitute for an FAA Security report. A1A Aviation Medicine, Inc.

Stratification • 0.08 to 0.149 BAC requires a preliminary substance abuse evaluation (Likely by a SAP). – By a physician addiction specialist or psychiatrist for Class I • Depending on findings, further investigations and/or testing may be required by FAA. (0.08 case) A1A Aviation Medicine, Inc.

Professional Pilot • On duty 0.04% is a positive DOT test. • 12 hours bottle to throttle and BAC no more than 0.02% for most airlines. • Airline Pilot after 8 hours on duty blew 0.022%. • 20 hours before the test he reports 2 vodkas and 2 whiskeys over one hour. A1A Aviation Medicine, Inc.

Drinkology • 0.15 – 0.19 BAC • Evaluation by board certified addiction or psychiatric physician, preferably HIMS trained • Modified HIMS program. A1A Aviation Medicine, Inc.

Drinkology • 0.20 BAC or pilot REFUSES alcohol testing on a traffic stop - FAA assumes pilot is an alcoholic. • Full HIMS program required to obtain Special Issuance. • Lose certification for 6 months, perhaps 2 years or longer. A1A Aviation Medicine, Inc.

Drinkology • FAA considers a second DUI - no matter how old and no matter the legal status - proof of alcohol abuse. HIMS required. A1A Aviation Medicine, Inc.

Drinkology • FAA takes independent medical certificate action even if charges reduced to less than intoxication (e.g. reckless driving), charges dismissed, or case expunged. • Court ordered evaluations, treatment, and education do not satisfy FAA. A1A Aviation Medicine, Inc.

What is HIMS ? • Human Intervention and Motivation Study (HIMS) • ALPA-FAA cooperative program – Originally for Major Air Carrier Pilots – Rehab less expensive than training a new pilot – Since 1975 >6,000 pilots returned to duty – Currently >1,300 flying with HIMS SIs – 85% of pilots in HIMS recover and receive a SI – 12% relapse once, 2% twice, 1 pilot three times A1A Aviation Medicine, Inc.

HIMS Program • 30 day or longer residential program • Detoxification (withdrawal) if necessary • Formal group aftercare • Alcoholics Anonymous or Narcotics Anonymous 90 times in 90 days, and then typically three times a week. • AA or NA and Pilot Sponsors A1A Aviation Medicine, Inc.

HIMS • HIMS AME typically monthly meetings • Documented Complete Abstinence • Random testing for alcohol and other substances – regardless of specifically abused substance. 14+ times/year • Soberlink – facial recognition A1A Aviation Medicine, Inc.

Special Issuance • Typically 6 months grounded • Good recovery demonstrated • Psychiatric & Neuropsychological Evaluation and Testing prior to SI. • Cost $10,000 for first year. • Little if any coverage by medical insurance, unless a major airline pilot. A1A Aviation Medicine, Inc.

Special Issuance Granted • After SI can fly, but HIMS continues – HIMS AME visits – Random testing – AA, NA, BOAF, after care, sponsors – Total program 3 to 5 years, but may continue for entire career. (Previously was 2 years) – Abstinence for as long as medical certificate is maintained – even if SI has ended. A1A Aviation Medicine, Inc.

HIMS Expectations • It will be longer then you think • It will be more difficult then you think • It will cost more than you think A1A Aviation Medicine, Inc.

FAR Definitions • Substance Dependence (Addiction) – Increased tolerance (Pilot with 0.33 BAC) – Withdrawal symptoms – Impaired control of use – Continued use despite damage to • Health • Social, Personal, or Occupational Functions A1A Aviation Medicine, Inc.

FAR Definitions • Substance Abuse – Physically hazardous (DUI) – Makes a person unable to safely perform as a pilot (toll booth error) – DOT drug test failure or refusal – BAC 0.04 or greater on DOT test • Both definitions are specific to FAA medical certification – not DSM-5 A1A Aviation Medicine, Inc.

Pilots’ Substances Drug of Choice Relapse Alcohol 91% 12% Cocaine 2% 24% Opiates 2% 42% Rx Opioids* 1% 33% HIMS relapse rate 15% AA relapse rate 60% A1A Aviation Medicine, Inc.

HIMS for Drugs • Similar to alcohol protocol • Typically longer before and after SI, because relapse rate is two to three times higher than alcohol. A1A Aviation Medicine, Inc.

MARIHUANA • State laws allow recreational (9 states) or physician prescribed use (23 states & DC). • FAA considers Marihuana in any form and for any reason an illicit substance – Schedule I with Heroin, LSD, Ecstasy A1A Aviation Medicine, Inc.

A1A Aviation Medicine, Inc.

MARIHUANA • CBD (cannabidiol) products • FDA approved seizure drug, Epidiolex • Unregulated CBD products often contain THC (tetrahydrocannabinol) and will show up as a positive on DOT and other testing. • FAA considers no form of marihuana or byproducts compatible with aviation. A1A Aviation Medicine, Inc.

MARIHUANA • If you ever used Marihuana… • If you have a positive test for Marihuana… – Passive or inadvertent exposure is not an acceptable excuse • You will need to be in a HIMS Program. A1A Aviation Medicine, Inc.

Risky • Substance possession or sales – Georgia beach possession – Marihuana candy in car – Cocaine sales Hong Kong • Positive alcohol or drug test by public or private employer, even unrelated to piloting or driving. • Marihuana mentioned to chief pilot. • New MedXpress examples. A1A Aviation Medicine, Inc.

A1A Aviation Medicine, Inc.