Federal Aviation Administration CAMA Certification Updates · Federal Aviation Administration AME...

Federal AviationAdministration

CAMACertification

Updates

NAME: Warren S. Silberman

Division: Aerospace Medical Education

Sept 2016

AME Updates: Sept. 8, 2016

Structure Changes to Guide• 3 columns (was 4)• Moved the “class” to top of page• Look for “Updated” dates• USE THE DISPO TABLES---to help a/m

collect the info we will ask for

Updates---how to find changesLast Wed of the month: AME guide “archives section” with links

– AMCS banner

– www.faa.gov/go/ame

Structure Changes -- AME aids• Disposition table updates• CACIs• Status Reports• AME Checklist• Certification Aids• Airman Questionnaires• Pharmaceutical sections

Disposition tables• Start here• Many conditions can now be cleared by the

AME at this step• Need block 60 notes

Has it been updated?• Old version • New version

Disposition table changes

CACIs---4/9/2013• Allows AME to issue from the office without

calling the FAA.• Start with the Disposition Table first• If CACI is needed--Follow the worksheet• If NOT CACI qualified—most likely will AASI

CACIs• AME can issue if the

worksheet criteria aremet

• Worksheets Do NOTneed to be submitted toFAA

• Current conditions:

If NOT CACI qualified• See what info to submit• Middle column• Possible AASI or SI

CACI vs Special IssuanceCACI Special issuance

Where to find info to submit Dispo table first, then CACI Dispo table

Initial presentation AME can issue if conditions aremet

AME must defer

Follow up AME can issue if conditions aremet

AME can issue follow up withvalid Authorization Letter

Reports are due 1st and 2nd—annually3rd class—at each exam (2 or 5years)

Per Authorization letter (mostare annual)

If not qualified May be special issuance Defer for FAA decision

Reports submitted to FAA No—keep in your records Yes

Time limited cert NO Yes

CACI-- Pearls• See if CACI is even needed (dispo tables)• Review the required documents• Block 60 notes

CACI block 60• Previously:

– “Airman meets certification criteria forhypothyroidism”

• NOW– CACI qualified hypothyroidism

• Working on a CACI button (IT $$)• If no block 60 notes—it is an AME error

Status Reports• Must be signed and dated• Can take the place of clinic notes• Must be submitted to FAA

• Current:– Diabetes– Gender Dysphoria

AME Checklist• Must be signed and dated• Does NOT take the place of

clinic notes– Allows AME to issue a follow up

if criteria met

• Must be submitted to FAA

• Current:– SSRI recert– HIMS recert

Certification Aids• Designed to treating

providers• Does NOT need to be

submitted• Must be submitted to FAA

• Current:– SSRI recert– HIMS recert

Airman Questionnaires• Designed to collect history

from the airman• Must be submitted to FAA• Only used for specific

conditions

• Current:– Seizure history

Pharmaceutical section

• Designed to identify medsallowed/not allowed/waittime

• Only used for specificconditions

– Do Not Issue –Do Not Fly list– Pharmaceuticals table

Pharmaceuticals• Pharmaceutical table

Changes since 3/2015– Seizure history sheet added– SSRI and HIMS standardization– Remove ATCs (x color vision)– Student Pilot combined cert

remove 4/1/16– Mitral valve repair– Gender Dysphoria– Chronic Kidney Disease– HTN medication section expanded,

CACI updated, 7 days, new AASI,FAQ

– Kidney stones---big changes,CACI, AASI

– Renal cancer CACI

– PC and TC have CACI worksheets– ED/BPH meds– Bladder cancer CACI– HIV prophylaxis meds– Hypothyroid 1 year TSH is ok– Diabetes. IDDM—3rd class send to

AMCD/RFS. 1st/2nd class decisionreview at HQ, DM form, metformin14 days

– CACI wording changes

SSRI Program Changes• Initial

– 6 months on meds (was 12) to consider for initial Authorization– AME must defer– Worked at HQ

• Recerts– Can be issued by HIMS AMEs in some cases– Must now see face to face every 6 months– Checklist

SSRI and HIMS—AME pearls• Current auth letter is ok to use• Will get new auth letter saying 6 months

• AME phone calls/complaints---HQ• AME questions—send to AAM-220• SEE HANDOUT (checklist and cert aid)

SSRI• www.faa.gov/go/ssri

HIMS• www.faa.gov/go/HIMS-DA

Student Pilot changes 4/1/16• Removal of the COMBINED student pilot

certificate and medical certificate

• AMEs—continue to perform AME medicalexams.

• Student need a medial prior to solo

Student Pilot – AME pearls• 1) MFT needed---AME should defer• 2) Restrictions eliminated

• Valid for MFT only• VSPPO—valid for student pilot purposes only• Not valid until (mm/dd/yy) age 16

• 3) Language requirement—FSDO• 4) Transmit all w/in 14 days

Student Pilot – where AMEs arehaving trouble• Think they cannot do the medical if they are

a student• Places to go for help• www.faa.gov.go/ame

Mitral Valve Repair

Mitral Valve Repair• Followed indefinitely• Previously all Special Issuance• Now 5 or more years out—possible CACI

Mitral Valve Repair

Mitral Valve Repair -- CACI

Mitral Valve—not CACI qualified• Mitral Valve REPLACEMENT• Any other valve• Any other additional valve• Any of the Co-morbid conditions

Mitral Vale Repair–AME Pearls• If 5 or more years out---- New CACI

– see if CACI qualified– What’s NOT a CACI

• Other valves• Other cardiac conditions• Co-morbid conditions

– Echo results—use the CACI worksheet• If not—may qualify for AASI (annual c/s and

echo)38

Gender Dysphoria

Gender Dysphoria• The AME may ISSUE (no further information is needed), if the

airman:• Was evaluated for or diagnosed with Gender Dysphoria and

has never undergone treatment (counseling or support groupfor GD does not require information);

• Has no history of other mental health diagnoses or treatment;and

• Is otherwise qualified

Gender Dysphoria

Gender Dysphoria—Status Report

Gender Dysphoria–AME Pearls• 5 or more years stable on meds—AME may be able

to issue• Change in status may reset 5 year clock

• Use the AME Gender Dysphoria Status Report• If airman has shaded answers---send in addition

Chronic Kidney Disease

CKD – AME Pearls• New CACI• New AASI

– New info in the guide– eGFR – if other testing was done, have the airman

submit

Hypertension

Hypertension (HTN)

Hypertension (HTN)---- FAQs

Hypertension (HTN)—Pharmaceutical Section

HTN—if airman does not meet 155/95

HTN- AME Pearls• CACI is based on # of component meds

– Lisinopril/HCTZ is 2

– 7 days no fly when starting meds– (was 14 day no fly)

– New AASI if 4 or more meds

Kidney Stones

Kidney Stone(s)

Kidney Stone(s)(Nephrolithiasis, Renal Calculi)

Or Renal ColicAll Classes

Updated 9/30/15 4/27/16

DISEASE/CONDITION

EVALUATION DATA DISPOSITION

A. Most recentevent/diagnosis 5 ormore years ago

No symptoms or current problems. Renal functionhas returned to normal. No ongoing treatment orsurveillance needed.

ISSUESummarize this history inBlock 60.

B. Less than 5 years agowith no complications*

Single stone that haspassed

If a single stone passed or is in the bladder withno further problems and imaging (such as a KUB)verifies no retained stones:

ISSUESummarize this history inBlock 60.

Kidney Stones--retainedC. Less than 5 years ago with no

complications*

Retained, asymptomaticstone(s)

Follow CACI worksheet.

Use this for retained, asymptomatic or incidental stone(s).

Follow the CACI RetainedKidney Stone worksheet

Note in block 60.

Kidney Stones--retained

Kidney Stones – AME Pearls• 5 or more years ago---AME may issue• If retained stones

– No complications– Possible CACI– If complications---possible AASI– Size and number no longer requirement. Urologist

needs to state if treatment is needed.

Kidney Stones—when NOT CACI

Renal Cancer

Prostate Conditions & Cancer

Prostate Meds

Prostate Cancer -- CACI

Testicular Cancer

Bladder Cancer

HIV prophylaxis

Hypothyroid• TSH within the last year for CACI• (was 90 days)

Diabetes• Up to 3 meds allowed

Diabetes -- DM Status Report

Diabetes – Metformin 14 days

Diabetes—Acceptable Combo Meds

Diabetes• B-blockers and insulin• B-blockers and sulfonylurea• ALLOWED

Diabetes---IDDM• 3rd class---as before• 3rd class who wants to upgrade---ok to issue

3rd class if qualified and a/m wants in themeantime (per auth letter) while HQ workson the upgrade

• 1st/2nd – worked at HQ

OSA 3/19/15

Skin Cancer updates

Liver transplant

Summary• Condition Changes• Updates

– Dispo tables– CACI– New AASIs– AME & treating physician tools

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