Updates to Congressional Directives
By Dr. Susan Northrup, FAA Federal Air Surgeon
Last issue, I addressed some of the changes we’re developing in MedXPress, including the portal to upload documents. In this issue, I want to touch on some of the other initiatives that are underway. If you’ve looked at the most recent FAA Reauthorization Act of 2024, you’ll note a significant overlap with the congressional directives found in sections 411 (discussed in this article) and 413 (the portal that was addressed last issue).
Section 411 established the Aeromedical Innovation and Modernization working group, of which I am a co-chair. The working group, which includes representatives from government agencies, allied civil aviation authorities, academic institutions, airlines and business aviation, unions, advocacy groups, and many experienced AMEs, is reviewing FAA processes and providing suggestions relative to the 2024 Reauthorization.
Many of the initiatives directed by the FAA Reauthorization Act are already ongoing. These include reviewing the medical conditions that the AME may issue. We already have disposition tables and CACIs (Conditions an AME Can Issue). We regularly review and expand the special issuance (SI) process, which includes protocols to authorize a medical certificate for different medical conditions, such as mental health conditions, neurological disorders, or cardiovascular disorders. A few years ago, we updated the follow-up protocols for the Human Intervention Motivation Study (HIMS), the program to allow pilots back into the cockpit once in stable remission from substance abuse, initiating the step-down process, which decreases monitoring over time in certain pilots.
The FAA Reauthorization directs a review of several specific conditions for potential changes in FAA policy. The first is treatment for red-green color blindness (sic, should refer to deficiency). As many of you are aware, the FAA does not currently authorize the use of “color enhancing” lenses for flight or color vision testing. The reason is that historically, these enhanced some color wavelengths by blocking others. Testing did not indicate a net improvement, even though, subjectively, some individuals reported improved color discrimination. Technology continues to improve, though, and we have ongoing research in cooperation with the Air Force to determine if any of the available enhancements are feasible in aviation, looking at both testing and operational use.
We are also specifically directed to review policy and guidance for attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD), as well as whether medications used for treatment can be safely prescribed to airmen. Several years ago, we developed a fast track for review of ADHD (now the accepted term) for those off medications for several years and asymptomatic. To date, this has been successful and expedited the medical authorization of many pilots. When we reviewed the medications used to treat ADHD, the side effect profile was not acceptable for aviation use. Individuals with ADHD may not realize they have channelized attention (they get so focused, they do not pay attention to anything else around them) or poor attention. Other concerns include whether they are medication dependent, and if they stop or forget their medication, how it will impact their performance. The working group will review the current literature to see if any medications can be used safely in some circumstances.
Another item is to review the appropriateness of SI renewal by the AME following a medical evaluation and treatment by a medical specialist. Currently, the AME Assisted special issuance (AASI) program for an AASI or SI condition is that the FAA grants the initial AASI/SI. The AME is then authorized to issue a medical certificate if specific criteria are met — determined by the condition with individual consideration. They include specific evaluation criteria from treating specialists. We will take this opportunity to evaluate the current program for efficacy as well as potential conditions for program expansion.
Congress also directed us to review current protocols regarding recertification following recovery from an illness or injury that resulted in a disability rating from the Department of Veterans Affairs. Currently, an applicant for a medical certificate must report receiving a disability rating on the application. Depending on the condition, the underlying condition(s) could delay issuance of the medical certificate. The working group will review current processes and protocols for both.
Finally, the working group will review the progress of implementing the recommendations of the Mental Health and Aviation Medical Clearance Rulemaking Committee (PDF), ICAO, and the Department of Transportation. Stand by for future updates!
Dr. Susan Northrup received a bachelor’s degree in chemistry, a medical degree from The Ohio State University, and a master’s degree in public health from the University of Texas. She is double board-certified by the American Board of Preventive Medicine in Aerospace Medicine and Occupational Medicine. She is a retired U.S. Air Force colonel and a former regional medical director for Delta Air Lines. She is also an active private pilot and aircraft owner.
