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Federal Air Surgeon's Medical Bulletin • Vol Federal Air Surgeon’s Medical Bulletin Aviation Safety Through Aerospace Medicine For FAA Aviation Medical Examiners, Office of Aerospace Medicine Personnel, Flight Standards Inspectors, and Other Aviation Professionals. Vol. 53, No. 1 2015-1 CONTENTS Federal Air Surgeon’s Medical Bulletin From the Office of Aerospace NEW OBSTRUCTIVE SLEEP APNEA GUIDANCE, TAKE 2 - - - - - - - - - - - - - - - - - 2 Medicine MAJOR POINTS IN THE NEW OSA SCREENING GUIDANCE - - - - - - - - - - - - - 2 Library of Congress ISSN 1545-1518 OAM ANNOUNCES PERSONNEL CHANGES - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3 Federal Air Surgeon James R. Fraser, MD, MPH OAM REMEMBERS DR. SAENGER - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4 Editor AVIATION MEDIcaL EXAMINER INFORMATION LINKS - - - - - - - - - - - - 4 Michael E. Wayda, BS CAMI RECEIVES ‘ACCREDITATION WITH COMMENDATION’ - - - - - - - - - - - - - 5 The Federal Air Surgeon’s Medical AVIATION MEDIcaL EXAMINER SEMINAR SCHEDULE - - - - - - - - - - - - - - - - - - - - - - 5 Bulletin is published quarterly for aviation medical examiners and NEW CAMI RESEARCH FacILITIES FULLY OPERATIONAL - - - - - - - - 6 others interested in aviation safety and aviation medicine. The Bulletin NEW VIDEO SERIES HIGHLIGHTS RECENT UPDATES AND is prepared by the FAA’s Civil COMMON ERRORS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7 Aerospace Medical Institute, with policy guidance and support from DR. FRASER RECEIVES CAMA AWARD - - - - - - - - - - - - - - - - - - - 7 the Office of Aerospace Medicine. Authors may submit articles and ALCOHOL -rELATED MOTOR VEHICLE ENCOUNTER WITH A COW - - - - - 8 photos for publication to: MEDIcaL CERTIFIcaTION OF A PILOT WITH GLOMUS JUGULARE FAA Civil Aerospace Medical TREATED WITH FRacTIONATED STEREOTacTIC RADIOSURGERY - - - - - 10 Institute P.O. Box 25082, AAM-400 AEROMEDIcaL IMPLIcaTIONS OF THE TREATMENT OF MALE Oklahoma City, OK 73125 HYPOGONADISM - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12 Attention: FASMB Editor Email: [email protected] ARTICLES PUBLISHED IN THE BULLETIN DURING 2014 - - - - - - - - - - - - - - - 14 The Federal Air Surgeon's Medical Bulletin • Vol. 53, No. 1 from the Federal Air Surgeon’s PERSPECTIVE... by James R. Fraser, MD, MPH NEW OBSTRUCTIVE SLEEP APNEA GUIDANCE, TAKE 2 bstructive sleep apnea is a disqualifying medical We will publish new OSA guidance in the Ocondition for an airman medical certificate under Guide for Aviation Medical Examiners Title 14 of the Code of Federal Regulations, part 67 (Medical Standards and Certification). Obstructive sleep apnea is a on March 2, 2015. significant cause of fatigue, and therefore it is a hazard to the safety of the National Airspace System and health of airmen. MAJOR POINTS IN THE NEW OSA SCREENING GUIDANCE Obstructive sleep apnea inhibits restorative sleep and can cause excessive daytime sleepiness, personality disturbances, cardiac • No disqualification of pilots based on BMI alone. The dysrhythmias, myocardial infarction, stroke, sudden cardiac risk of OSA is determined by an integrated assessment death, and cognitive impairments (decreased memory, attention, of history, symptoms, and physical/clinical findings. planning, problem solving, and multi-tasking). • The OSA screening process must be completed by the Citing the significant medical and safety implications AME using the American Academy of Sleep Medicine of obstructive sleep apnea (OSA), plus the fact that it is guidance to be provided by reference material incor- underdiagnosed in the U.S. pilot population, as well as ob- porated in the Guide for Aviation Medical Examiners. serving recommendations from the National Transportation Safety Board (NTSB), the FAA Federal Air Surgeon proposed • Documentation of the OSA screening can be provided guidance to aviation medical examiners (AMEs) on screening by the AME simply by checking the appropriate block for OSA [“New Obstructive Sleep Apnea Policy,” Federal Air while completing the airman’s 8500-8. Surgeons Medical Bulletin, Vol. 51, No. 4, p.2]. • Pilots determined to be at significant OSA risk will At that time, Dr. Tilton advised AMEs that they would be be issued a medical certificate and referred for an expected to calculate the body mass index (BMI) for every air- evaluation. man and refer individuals with a BMI of 40 or higher to a sleep medicine specialist to determine need for treatment. Following • OSA evaluations may be completed by any physician treatment, if indicated, these individuals would receive Special (including the AME), not just sleep specialists, using Issuance medical certification. While the proposal was designed the American Academy of Sleep Medicine’s guidance. to identify only the highest risk individuals, the announcement • Evaluations do not require a laboratory sleep study created concerns in the aviation community and ultimately or even a home study if the evaluating physician resulted in proposed legislative prohibitions from Congress. determines the airman does not require it. Responding to industry stakeholder and Congressional • concerns, the Office of Aerospace Medicine deferred issuing Results of the evaluations can be given to the AME, ne w OS A me d ic a l scre en i n g g u id a nc e to A M E s. We h ave subse - forwarded to the Aerospace Medical Certification quently worked with AMEs, pilot advocacy organizations, and Division (AMCD), or sent to the Regional Flight the aviation industry stakeholders to incorporate their ideas for Surgeon’s (RFS’s) office within 90 days of the FAA a more inclusive approach for airmen that would also address exam to satisfy the evaluation requirement. The pilot the safety concerns of the FAA and the NTSB. continues to fly during this period. I believe this new OSA screening guidance will significantly • If the pilot needs additional time beyond 90 days to improve upon the safety of the National Airspace System. A complete the evaluation, a 30-day extension will be significant secondary benefit will be improved pilot health granted by the AMCD or the RFS on request. and career longevity. The changes in the certification process substantially expand physician screening options to reduce the • Pilots diagnosed with OSA can send documentation frequency and costs of unnecessary evaluations and testing. of effective treatment to the AMCD or the RFS’s For those airmen determined by the AME to be at substan- office in order to receive consideration for a Special tial risk, one of the most significant benefits is the result of the Issuance medical certificate. issuance of a medical certificate with accompanying Federal Air • The FAA will send the pilot a Special Issuance letter Surgeon request for further evaluation. This will save months documenting the follow-up tests required and timing of flying—compared to the current policy requiring deferral. of the reports. Overall, aviation safety and pilot health will be enhanced while reducing the financial burdens and disincentives for • Most follow-up reports will only require usage data obtaining OSA evaluation and treatment. Improved AME from the CPAP machine and a brief statement from and pilot awareness of the dangers of OSA and the benefits of a physician. treatment will continue to grow. —Jim 2 The Federal Air Surgeon's Medical Bulletin • Vol. 53, No. 1 The Federal Air Surgeon's Medical Bulletin • Vol. 53, No. 1 3 OAM Announces Personnel Changes By Michael A. Berry, MD, MS Deputy Federal Air Surgeon Dr. Giovanetti Receives Headquarters Assignment New Alaskan Regional Flight Surgeon Selected I am very pleased to announce that Penny Giovanetti, DO, We are pleased to announce that MS, was selected to manage the Office of Aerospace Medicine’s we have selected Marcel V. Dionne, Medica l Specia lties Division in Wash- MD, MSPH, as the new Alaskan ington, D.C. She brings a great deal of Regional Flight Surgeon to fill Aerospace Medicine experience from the position vacated by Dr. Willis her time in the Air Force and with Simmons. We are very excited to the Aerospace Medical Certification have Dr. Dionne join the Office of Division in Oklahoma City for the Aerospace Medicine family and ask past 2 ½ years that you welcome him to Alaska. In her new position, Dr. Giovanetti His start date was January 11, 2015. is responsible for developing aerospace Most recently, Dr. Dionne served Dr. Marcel Dionne me d ici ne pol icie s a nd proc e du re s, over- as Director of Medical Services, Alaskan Regional Flight Surgeon seeing the process of medical appeals Dr. Giovanetti Fairweather LLC, a company pro- to the Federal Air Surgeon, providing Manager, Medical viding advanced logistics services to oversight of FAA employee drug and Specialties Div. offshore oil companies in Anchorage, Alaska. Prior to that, he alcohol testing, managing and admin- had a distinguished 21-year career as a Flight Surgeon in the istering complex psychiatric cases, and providing aerospace United States Air Force, retiring in 2013. In the Air Force he medicine expertise and advice to the Federal Air Surgeon. had a number of command positions, one of which was the Dr. Giovanetti joined the FAA in August 2012, coming from Chief of Aerospace Medicine at Elmendorf AFB, Alaska, for private practice in Physical Medicine and Rehabilitation. She five years. His last assignment was as a medical inspector and retired from
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