A meeting was held in Wellington hosted by the Civil Aviation Authority, and attended by CASA’s Deputy Principal Medical Officer, Dr Tony Hochberg.
This was an opportunity to exchange ideas about a range of topics:
- CAA and CASA are looking at a harmonisation of medical certification. Given the complexities and timescale for legislative change, this is a process more easily achieved by change from the bottom up. The content of the application and examination focussed on improving the evaluation of key aeromedical issues ie alcohol and mental health. An important consideration is the introduction of an online system by the CAA. This radically alters the data collection process.
- Online certification. CASA shared some of the upgrades to MRS. This is an ongoing process and includes new medication reference for AMEs, as well as improved and intelligent pilot assessment support. CAA are progressing online implementation and the medical developments are due to be demonstrated in May 2023.
- Recertification post-stenting. Good longitudinal data (5years) has permitted revaluation of post-intervention risks. A key finding indicates the impact of rigorous risk factor management, especially lipid lowering with statins. Prognosis is dramatically improved with LDL <1.4 and <0.4 resorption occurs, leading to a reduction in absolute risk. Medical Management has assumed greater importance. Functional testing remains appropriate and CAA will be developing an updated assessment paradigm. It is likely there is a small subset of pilots able to fly solo-pilot ops post-stenting.
- Cardiovascular risk. PREDICT has been adopted for risk assessment by both Authorities. It has led a large reduction in exercise testing compared with Framingham based calculators. The CAA require functional testing at an annualised risk of 2% or more, CASA 1%or more. It would be good to agree a common threshold.
- Air Accident Investigation. ICAO incorporate an SMS approach to aeromedical assessment. Data from occurrences should be fed back to the regulators’ medical units to inform the process. This is not happening and it was proposed that an approach should be made to TAIC to see how this requirement can be met.
- Public Health and aviation-specific advice. It was noted that neither regulator was contacted for advice during the recent COVID pandemic. Given the evident deficiencies in management of the aviation sector but agencies unfamiliar with the operational environment, Dr Hochberg will draft a letter to Health and Transport Ministries for joint signature by the group, suggesting proactive engagement where aviation may be affected or implicated in disease management measures.