 Hello everyone and welcome to the FAA Forum. This morning's program will be about the medicine, aerospace medicine that's going on in the updates. Our speaker today was a Navy Air Surgeon. He served on the Theater of Roosevelt and today he's stationed in Washington and Mr. Dr. James Fraser is the Deputy Federal Air Surgeon. So please welcome Dr. James Fraser. Alright, well good morning. It is a pleasure to be here from Washington, D.C. I can tell you it took a while for winter to start. We had a warm December and in the beginning of January it was somewhat warm but we've had a definite winter ever since. So it was not spring yet when I left and it's a pleasure to be down here in Florida. This is my first time at Sun & Fun and I'm delighted to be here. I am James Fraser, I am the Deputy Federal Air Surgeon and today I'd like to do three things. I'd like to start off by spending just a couple of minutes telling you a little bit about my background so you know where I'm coming from and then I'd like to talk about some of the programs that we have in Aerospace Medicine and particularly how we at headquarters play in these programs. And then lastly I'd like to talk about some of the current issues that we have in Aerospace Medicine and certainly open it up to any questions that you might have. Fortunately I am joined by my colleague up front, Dr. Richard Carter who is here working the booth for FAA Aerospace Medicine and has helped some 60 or 70 odd airmen here at Sun & Fun with particular medical questions about their particular case. And since Richard works at the Aeromedical Certification Division at Cammie in Oklahoma City if there's any particulars about certification that come up during the question and answer session, Richard's here to help me out. So I appreciate you coming in, Richard. I will start by just telling you a little bit about my own background. I've not been with the FAA as long as a lot of my colleagues. I joined the FAA about three and a half years ago after the Navy sent me a letter telling me that 30 years of fun was all the time a sailor was allowed to have. So at that time I was fortunate to be able to apply to a position at headquarters with the FAA and I couldn't be happier to be where I'm at and to be doing what I'm doing. I'm not new to Aerospace Medicine, I've been doing that a long time. As far as my Navy career is concerned I started out life as a Mark I, Mod Zero family physician and after residency and working as a staff family physician teaching family medicine. I went overseas to first the Philippines for three years and Scotland for three years and was able to take my family and had a great time overseas and learned a lot about family medicine but I had always wanted to be a naval flight surgeon. So before I got too old I was able to apply to the naval flight surgeon program and subsequently went to Pensacola, Florida where they taught me to fly an airplane. I no longer had call every other night and because they started giving me flight pay I got a pay raise. So what a deal. I have been in Aerospace Medicine ever since. I stuck around in Pensacola and did a second residency in Aerospace Medicine. Following that I did what a lot of Aerospace Medicine specialists do in the Navy. I went to be a senior medical officer on one of our nuclear aircraft carriers, the USS Theodore Roosevelt which was an honor and some of my best sea stories come from my time on the carrier and the adventures of their own. So if you don't have any questions I can always tell sea stories. Following my time on the Roosevelt I stayed on the east coast and joined Commander Naval Air Force Atlantic Fleet where I had oversight of what was then seven aircraft carriers on the east coast and their medical departments as well as all the naval flight surgeons and physicians working in the Atlantic Fleet. And then my final seven years in the Navy was still in Norfolk Virginia where I was at the Naval Safety Center and as the Naval Safety Center surgeon I had the opportunity to train all naval flight surgeons. I had the opportunity to work with the highest levels of naval aviation in terms of lots of safety initiatives to make Navy and Marine Corps aviation safer and I had the opportunity to participate in all the Navy Marine Corps fatal mishaps and I in fact ended my career in the Navy by being invited to be a member of the Columbia Accident Investigation Board or what we called the Cade so we got to spend three and a half months at Houston before I went home. But as I said in the beginning the Navy did send me a letter and I was very fortunate to be able to apply for position at headquarters and started there as a manager of medical specialties and now for over just over a year I've been the deputy federal air surgeon. So I want to talk a little bit about the programs that we have in aerospace medicine and then we'll get into some of the current issues and some of the good news stories at least I consider them good news stories that I'm anxious to share with you. Aerospace medicine is part of aviation safety. We are the third largest service of course the big the big gorilla is flight standards which comprises some 6000 plus personnel and then aircraft certification which is a couple of thousand and then we are a very distant third with some 330 FAA personnel scattered in nine regions all across the country and at Cammy. Now despite the fact that we're the only the third and a distant third in terms of size we do have the largest number of designees and as many of you know and as I'm sure some of you probably are aviation medical examiners so we have a very robust program where we train aviation medical examiners that act as our agents to medically certificate airmen all over the world. We are the appellate level of aircraft medical certification oh and before I go on to that I could I want to just say that that not only do we develop standards for airmen and air traffic controllers one of the really interesting things that I get to be involved with at headquarters is the development of standards for commercial space flight crew and passengers that could be a lecture in and of itself as could the development of standards for UAV operators UAVs as you know are becoming far more common in this country there's UAVs flying in our airspace as we speak and what constitute a medical certification for a UAV operator is also a lecture in and of itself i.e. what is a UAV anything from a model airplane to something as large as a standard air carrier and how much control does the UAV operator have over the flight services I mean some flight surfaces some of the operators have to have the dexterity and skills of a pilot and more so and then other UAV operators have nothing more to do than go turn on the switch so there's a so there's a great deal of discussion that's been fun to participate with in terms of how we medically certificate UAV operators and we get into such things as psychological testing and how do you drug test these folks or do you drug test these folks and we we certainly at headquarters spend a great deal of time in developing policy and standards we do serve as the appellate level or the final level in aircraft or airman medical certification if an AME defers an airman to AMCD in Oklahoma City and then if AMCD does not certificate that airman every airman has the right to appeal to the federal air surgeon in which case the the case comes up to us in Washington and we look very closely at these very complex I mean by the time it's been vetted through the AMEs and through Kami we know we have very complex medical and psychiatric cases but we look at these very closely I can tell you even though our first mission in the FAA is to make sure that we maintain the national airspace and keep it safe a very close second is our efforts to get every airman that we that we can up and flying we work very hard to to to see if we think an airman is safe not for the career like we did in the Navy or you would do in the military but for the period of their medical certificate so six months one year two three or five years for three for third class and if we think that airman can safely fly we'll get him up and in fact I am very proud of the fact that if if you work with us in aerospace medicine even if you have a very serious medical or or psychiatric issue we're probably going to get you up in the air if you look at the numbers only one tenth of one percent of airmen are ultimately final denied now there there is something under just 10% that may be deferred by their aviation medical examiner and then it goes to AMCD and we may need more information we may need to authorize what we call a special issuance whereby we will require that airman to periodically get special testing and and will will condition his medical certificate of him continuing that medical testing but having done so only one tenth of one percent of all airmen that apply to us are ultimately denied and I'm very proud of the fact that we get so many folks up in the air as we do we we the FAA serve as a gold standard or a benchmark for the rest of the world and I can tell you that that many of the certificating authorities from from the rest of the world are are sometimes amazed at our willingness to authorize such things as diabetics that use insulin to fly airplanes certainly very few countries in the world would allow such things as that so in Washington we work hard we use we use we do a lot of literature review and we use the best of of what we call evidence-based medicine to determine what can and and cannot be safe when you fly an aircraft and we are we are not afraid to certificate a number of things and we'll touch on some of those in just a moment we play big in occupational health in terms of development of policy and I can tell you being at Washington DC it's very interesting we work with NIH and CDC and the Department of Homeland Security and we work on how we would handle communicable disease like tuberculosis or SARS we work with how we would handle emerging disease like avian flu we work with how we would handle bioterrorism agents and it's quite an interesting world to talk with these various other agencies and develop plans as as to how we in the FAA and aerospace medicine would interact with these agencies in event of communicable disease emerging diseases or bioterrorism we also do the more mundane things like decide which size aircraft need to carry AEDs automatic external defibrillators and all of you need to help me between my navy acronyms and my medical acronyms if I start talking in tongues please please raise your hand and stop me and I'll slow down and and try to be plain spoken but we determine how big a plane needs an AED we determine which plane needs medical kits and what goes into those medical kits how many first aid kits you need and things of that nature in aerospace medicine we are we have a big role in the substance abuse substance dependence world we run the industry substance abatement program and as such we have a have a very robust program whereby we test pilots and maintainers of commercial aircraft and we inspect those air carriers or those maintenance entities to make sure that they have the appropriate drug programs and we want to make sure our commercial pilots and maintainers aren't on drugs when they're taking you from point A to point B we also have our own internal substance abuse program whereby we drug test all of the safety and security sensitive personnel which is mostly air traffic controllers but we we also maintain our own internal program and finally I'm very proud that the FAA is once again a world benchmark in terms of developing a HEMS program and HEMS is human intervention model but basically it's a program that some of you may be familiar with whereby commercial pilots can work with the union can work with the FAA and and once diagnosed or identified as a substance dependent person can be rehabilitated and can be brought back into a career as an air transport pilot we have we have been able to identify thousands literally thousands over the 20 years that we've been a part of this HEMS program commercial pilots and rehabilitate them and bring them back to active lives as as air transport pilots and husbands and fathers and and and we continue to play a big role in working to make sure that we identify these kind of folks and offer the kind of services they need we play a big role in air medical education I think I touched on that I think there's something like 3,500 aviation medical examiners scattered all over the world so we hold regular seminars where we train doctors that want to become aviation medical examiners we also have required refresher training for these AMEs that we provide all over the country and we also train airmen we like to come to venues such as Sun and Fun or Oshkosh and other air shows and fly-ins and have been able to provide regular physiologic training to thousands of airmen and lastly I'll mention research we play a big role in terms of air medical research both at CAMI and and beyond at CAMI we have both human factors research where we look into such things as fatigue issues for not only pilots but flight attendants and for air traffic controllers we look into such things as how important color vision is for pilots and for air traffic controllers and we we learn some interesting things I you know we now have some very sophisticated screens that controllers use that have many colors and technologically you can you can create dozens of different colors and we know from scientific studies that color can be a useful tool in terms of making important information on a chart more readily available but despite the fact that we have the capability to technologically create dozens of colors we've learned that the human brain can really only process about five or six of those colors in an expeditious manner so we continue to learn new and interesting things about how important color vision is for for people in aviation we also do a lot of the the aeromedical research in terms of crash survival and and evacuation plans and systems and how people evacuate into water and survive we look into crash worthy seats we do a lot of research in the chamber uh looking at the hypobaric environment hypoxic environment so there's a lot of great research that's done at cammy some of that research you may have read about some of that some of our own research was recently quoted by congressman over star who is chairman of the house transportation and infrastructure which is what the aviation subcommittee falls under but congressman over star used one of our own studies that was done from work that is the result of having our toxicology laboratory we have a world class toxicology laboratory whereby if there's a fatal mishap we have tissue samples and and basically can determine amazing things not the least of which is what medications or what medical conditions the fatal that the pilot may have had in the case of a fatal accident and we in order to do the typical quality assurance that is required to maintain our status as a world class tox laboratory we we looked at the airman's 8500 tac 8's to look and see what medications or medical conditions they had listed on their on their medical in order to corroborate the fact that our laboratory picked up what they said they had or the medication they were taken and and we found that that our laboratory was indeed good if they had a given medical condition we were pretty doggone good at at determining that during toxicology if they were taking medicine it was certainly easy to corroborate the fact that they were taking that medicine but what we learned is that there were 8% or so of airmen that had a medical condition or were taking a medication that they didn't put on their 8500 tac 8 so in in in the concept that no good deed goes unpunished congressman over star quoted our own study and we soon get to participate in congressional hearings another joy of being in the DC area whereby we will we will be able to discuss this with congressman over star and other members of the committee we the FAA aerospace medicine don't think that falsification of the 8500 tac 8's is a huge issue certainly it happens certainly it can potentially be a problem but to you have to use the resources to match databases as congressman over star has suggested we think perhaps might not be the best bang for the buck so we are anxious to engage in that conversation and more to follow okay let me talk about some of the some of the decisions that have been reached some of the recent changes that have been made that are examples of how we are using the best of evidence-based medicine to allow airmen to fly with medical conditions that were once thought incompatible with aviation multifocal lenses for for those of us that have reached 45 or 50 and beyond and we suddenly find that our arms aren't quite long enough you have a choice you can either get bifocals which of course you have to carry and carry an extra pair in your aircraft or the we now have new multifocal lenses whereby if if you are interested in having the surgery you can have a multifocal lens put in and you'll never have to wear bifocals you'll you'll do this for reasons of cataracts or perhaps vanity but whatever the case there are there's enough literature out there that shows us that if you do want to have one of these multifocal lenses or it would have to be bilateral but if you have multifocal lenses implanted surgically will allow you to get your medical certificate and that would be a regular certificate it's not a special issuance we have developed in the past couple of years dozens of what we call AASI AME assisted special issuances and I know Richard participates in certification of lots of AASIs or quick cert as some people call them but we have taken incredibly complex medical conditions like myocardial infarctions or heart attacks and subsequent percutaneous transluminal angioplasty or stenting or even coronary artery bypass crafting serious diseases of this nature and and other diseases like aortic valve replacement or mitral valve replacement the the various dysrhythmias like atrial fibrillation which is very common in an aging population cancers be it breast cancer prostate cancer bladder cancer you name it we have developed protocols whereby an airman that has one of these 35 I think it is Richard 35 give or take conditions serious medical conditions that were once permanently disqualifying we now allow these airmen to submit the information the required information to AMCD and AMCD will issue a special issuance with a six-year authorization whereby following that first authorization at CAME that airmen can then go back to his AME he can provide the annual report from his cardiologist or from his his hematologist or whatever the case might be and and required testing depending on the condition but the airmen can take this information back to his AME and then without going to the hassle and sometimes delay of submitting all that stuff back to Oklahoma City the AME then gives the airmen a new medical certificate right then and right there and it's and the airmen walks out the door good to go for another year or two depending on the condition and once again is only required to get the current status report and whatever testing is directed and give that to the AME in the period specified so we are very happy with the fact that we've got lots of AMEs out there that are helping us do this there are some AMEs that are still unfamiliar with reading a stress test or evaluating some of the required information we require but it's catching on and and certainly if you were to have a condition of this nature it is not hard for you to find an AME that's willing to participate in these AME assisted special issuances and it would make your life much easier. Another example of a state of the art change is heart transplants. We are now giving special issuances to people that have had a heart transplant and that's not everyone that's had a heart transplant because you could still have lots of lots of problems. We once upon a time did authorize heart transplants but we learned that people that had transplants had a nasty habit of of dying suddenly and and we reversed that but now following the work of of many cardiac surgeons we have successfully identified a subset a subset of those people that have had heart transplants that we are able to safely certificate and the same thing goes through for hypertrophic cardiac myopathy that's that's the disease that athletes have that that is usually undiagnosed or I guess is always undiagnosed that that young usually young men have and and they die on the high school football field or on the basketball court and it's due to a enlarged septum and problems with outflow obstruction and subsequent dysrhythmias in the heart so this is the same thing that kills young athletes all the time but airmen get it too. We once were uniformly strict about disqualifying anyone that had this hypertrophic cardiac myopathy but just like heart transplants we've developed or been able to identify a subset of folks that we can safely certificate that has this condition and lastly I want to talk about some really good news for some time we've been working on a program called FAA MedExpress and just last Monday we actually put this online and made this available to airmen on the west coast so right now it's it's it's just western pacific northwest mountain alaska that we are allowing airmen to to use this but I feel sure that by the time we're here next year FAA MedExpress will be available to all of us but basically FAA medical express allows any airmen to go online and this is the screen that you would see online the first screen that you would see you go online and you electronically complete your 8500 tac 8 and there's some passwords involved because we have to protect medical privacy and things of that nature but it's been beta tested and it's it's now in active use and we have already had hundreds of aviators on the west coast that have told us that this is even this is easy enough to use that even fighter pilots can figure it out so we're very we're very excited about this basically you fill out all the information you fill it out at home in your pajamas where you have your medical records available you can look at the names of the prescriptions you're taking you can look at the the necessary information that you might not remember to carry with you to the AME's office so you fill this out you electronically submit and here you can see this is this is basically what the form looks like an electronic version of the 8500 you you you're given a confirmation number you then show up at your AME's office he punches the confirmation number into the computer pulls up the exam you've completed goes over the history with you completes the physical fills in the back of the 8500 tac 8 and sends it off and there's no paperwork involved it's a done deal now at present at present because of the rules requiring the wording that we have on the back of the medical certificate you actually receive the AME's are going to have to to tear up a paper form that you're used to and use the number and the actual medical certificate that comes on that form but once we go through OMB and and have everyone agree on the on the wording that we can use on a folded certificate the next great thing we're going to be able to do and this is for AME's not particularly for airmen is just have our AME's print out right there your certificate so the front will look just like what you're used to when you leave the AME's office and the back will have that stuff on it that that I never read but we're required to have in terms of periodicity and things of that nature so this we feel as a quantum leap forward you'll see lots of you may not be able to see it but but almost every field of the history there's a question mark and if you click on this as you are filling out this form you will be taken to our AME guide and you will be able to read specifically what we are looking for in terms of history of unconsciousness or history of heart disease or history of of whatever we link you immediately to the AME guide and we we like to think that this is a user friendly customer satisfaction instrument and I look forward to your comments about FAA MedExpress this time next year here's some more good news after working for the past couple of years we now have an NPRM notice for proposed rulemaking on the federal register so if if you wish to provide comment you can go online and and and tell us what you think but we after looking at the medical literature feel that we can safely certificate airmen under the age of 40 much less frequently than we have in the past for first class pilots if you're under the age of 40 we're going to go from six months to one year for third class if you're under the age of 40 rather than have a medical and a physical every three years we are willing to go every five years and that's going to save you folks a lot of money it's going to save us a lot of time but we have the scientific data to show that if you're under age 40 you're just not likely to suffer those sudden or subtly subtly incapacitating illnesses that we're so concerned about in aviation medicine so we think this is a win-win situation if you if you like the idea of of getting a physical list frequently please go online to the federal register and tell us so lastly i want to mention something that that typically always comes up at forums such as this we have an antidepressant medication working group and i can tell you that my boss dr fred telton is very serious about the fact that that he is willing to certificate airmen that are properly diagnosed and treated and our own antidepressants for the most part in a category of ssri's selective serotonin reuptake inhibitors these antidepressants compared to the old antidepressants are much safer there are other countries including canada and australia that already certificate a subset of airmen on ssri's ssri's are very commonly used every time i go to speak at a forum like this or every time i talk to ames i am always taken aside out in the hallway and told you know doc i know of a pilot that's taking this and he ain't telling you and of course even worse scenario are those pilots that are clinically depressed but because they know that faa rules prohibit the taking of antidepressants and flying an airplane uh they're not taking anything and and that and that too is uh is is something that that concerns us so we're looking at a subset of people that are depressed and of course we have to we have to rule out those cases of depression that are associated with suicidality or or psychosis and then we have to look at the class of ssri's and some are sedating and certainly have proven to interfere with cognitive processes something not good when you're flying an airplane but there's others that are less sedating and are less likely to interfere with these cognitive processes so we are seriously working on developing the protocol that will allow some airmen to to fly on ssri's and i will tell you one of the big problems that we have is that our concept of what we allow in the faa is somewhat different than what most certificating authorities allow in europe and in in many places of the world they'll take things such as depression or or heart disease and they'll restrict the pilot to a multi pilot crew which seems to make sense but we in the us we in the faa for a long time have always considered atps commercial pilots to be those that we most highly regulate we we feel the american public i'm sure the american public expects our atps to be free of serious potentially suddenly or subtly incapacitating diseases there are times in two pilot aircraft during critical phases of flight that two pilots are there for a reason so we hold our first class pilots to the highest standards and we allow pilots with third class medical certificates to fly to have to fly with some degree of risk for instance uh the diabetics own own insulin uh most of the certificating authorities think we're crazy for allowing that in single pilot aircraft and the so the same so the same concept works here many of the countries that now allow ssri's or antidepressants are only allowing it in multi piloted aircraft and that that is a concept that's diametrically opposed to the concept we hold at the faa whereby our third class pilots we allow to fly with conditions that might be somewhat more risky than those that we allow our first class air transport pilots to fly with but stay tuned i i am convinced that someday hopefully next year i will be able to come before you and tell you that we have a subset of ant of depressed pilots that have been followed and our own medication and we allow to fly i want to touch on just a few other issues and i won't spend a long time on these but certainly this is an audience where some of you may fly or be interesting in flying light sport aircraft and here are the operational limits for a light sport aircraft i bring this up because since we've had the the rule in part 61 of cfr regarding the fact that you just need a us driver's license to fly sport pilot there has been an issue with those folks that have been denied a medical in the past and of course the rule the statutory law states that if if for any reason you applied for an faa medical certificate and you were denied suspended or revoked you cannot use your driver's license to fly and i'm going to i'm going to state right now that i realized potentially there is some unfairness in this there could be twin brothers that have had bipolar disorder one brother applies for an faa medical certificate and he's denied the other brother never applies for an faa medical certificate he thinks he's just fine he hadn't been on medicine for a long time his doctor tells him he's just fine he goes and and purchases a light sport aircraft and flies with his driver's license so i i admit there's inequality there i'll state that right up front however the lawyers have repeatedly pointed out to us that by law we as as government service as regulatory physicians are required to act on information that we are aware of so if we are aware that someone has a psychiatric or a medical illness that is disqualifying you are not allowed to fly with your driver's license however the good news is there are many pilots out there that had heart disease that we used to deny regularly and now we authorize special issuance for these folks on a very regular basis uh cancer is another case that was was formerly uh frequently uh denied we now routinely allow people to fly with an with a special issuance so if if you were denied 10 years ago for a medical condition uh please consider reapplying for that medical certificate if you want to fly sport pilot we are a kinder and gentler f a a than we once were and lastly i want to close uh on on something that you're all aware of um you know that i k o on november 23rd instituted their age 65 rule whereby they allowed by i k o by i k o rules if you you can be a pilot over the age of 60 under the age of 65 and fly into this country because we are an i k o participant if the other pilot is under the age of 60 of course our f a a rules and it's not a medical rule but our f a a rules existent from 1959 say that if you're an air transport pilot today you reach age 60 you can no longer fly so once again there is great inequality in that people that are in other countries uh that don't fly in registered aircraft can fly into this country over the age of 60 whereas our own us pilots once they turn 60 they are no longer allowed to fly a in the us or in an in registered aircraft that comes and goes into the united states um after convening an advisory rulemaking committee that that dr tilton and i got to participate in um we made recommendations to the f a a administrator and she announced on january 30 that she was instituting a notice of proposed rulemaking this is quite a complex process which involves lots of lawyers and lots of economists but but the administrator has committed to posting this n p r m to the federal register by september of this year which is when her term in office will expire so i know there are people that are very adamantly for this there's people that are very adamantly against this but we medicine have taken the position in the advisory rulemaking committee that age in and of itself should not be the determinant of when a pilot can maintain his first class medical so so more to follow on that um i will tell you rulemaking is a long involved process it's certainly been a learning experience for me um there's there's a couple of things in life a man shouldn't have to watch one of them is the making of sausage and the other is rulemaking in washington dc uh it is it is going to be a long convoluted process but uh but we are serious about proceeding and becoming consistent with i k o and allowing our air transport pilots to fly beyond the age of 60 up until 65 with the same with the same rules that the other pilot be under the age of 60 so i could go on and talk about some of the research that neither proves nor disproves the fact that pilots over the age of 60 are safe uh or any other topic that you wish but i think it's time to to pause and take any questions it's yes sir i'm uh cabbage back in 86 uh i understood you know that soon the ames would be able to do this now last year when they renewed me they didn't grant me that reason that uh ability as my yeah uh is is there some reason for this is there a subset there as you refer to oh richard may be able to help me out here but i know if you if you had an authorization that we said was good for three years or whatnot if you already had a piece of paper that said every year we want to send we want you to send this information to cammy or we'll look at it and then if it looks okay we'll send the letter back to you that you take to your ame and he gives you your certificate we weren't we weren't going to take any existing contract that we had with you and create it uh or or give you an asi we were going to wait and and give you a new a new contract so to speak is that correct richard the most complex cases we're considering for asi are the so-called quicksurf are the cardiac cases such as uh history of bypass stent and so on and so forth the certification division alcolma city which is a branch office of the federal air service office that reviews these in a special cardiac unit automatically review every airman's case with a history of cardiac conditions for consideration of the asi that's automatically done and in all new letters being sent out to airman we specifically address to them usually in block form highlighted bold lettering in there that you were considered for quicksurf for your cardiac condition and specifies if that was not able to be done typically the reason for that is that as you know for cardiac conditions one of the key requirements is a follow-up stress test if that stress test is in some way more complex more difficult to interpret than is many times the case then we reserve those more complex cases only for the cardiac unit or the federal air service cardiologist to review if the stress test appears to be more routine more easily observed to be normal to the casual physician observer then we do try to delegate those cases for quicksurf because that allows the AME to do these annual medical reviews and issue the certificate to delay certification for to minimize delayed certification for the airman I would think that the nature of the question he was asking would be related to the the more complex cardiac cases did that help and and I might and I might state that that we are Richard and the regional flight surgeon from southern region Walt Davis are going to be here the rest of the week and I'm going to be here the rest of the day so if there's any questions that you would like to ask about a particular medical condition I would I would suggest that you come to the booth which is just next door here and we have the capability to look at the electronic version of your record and get back with you with some some real-time news unlike the old days where we just had to take your name and number and say we'll we'll get back with you yes sir yeah dr. freezer I have a question regarding a sport pilots there are restrictions on the type of airplanes weights or performance for sport pilots are these restrictions based on medical decision or medical facts no the operational limits for what constitute a light sport aircraft were developed by flight standards and I could only say that we and medicine were were generally aware that we were looking for an aircraft that generally would fly low and slow but but there is nothing evidence based or or scientific specific information regarding the numbers they came up with regarding gross weight speed stall speed etc regarding the sport pilot and medical considerations it's an interesting development that in this newly emerging technology there are companies that are specifically targeting unique medical situations for example disabled there are newly developed sport aircraft that are developed to specifically meet the fa standards that are designed at the factory for disabled pilots that are interested in flying this is one of the unexpected but intriguing aspects of the sport pilot program so in that respect there will be medical interest in the air medical certification division regarding these newer types of aircraft where decisions will have to be made regarding medical flight tests the most intriguing of one of these aircraft is a sport pilot aircraft designed to meet those specific requirements that will allow both the instructor pilot and the student to both be disabled with dual hand controls a really interesting development those cases will come to our attention because we'll have to give a medical flight test approval for in essence the instructor pilot and the student yes sir could you address the cycle time and the cycle time is measured by what's of interest to pilots and that is the date of application to the date of award and put it on the stage of in March the u the FAA released a press release saying that that cycle time was now down to 24 days but that followed on the heels of the administrator in at air venture last year saying that that time was down to 16 days so first of all that improvement obviously is not not an improvement and secondly any of us any of those in the room who've been through this know that you hardly process a single piece of paper in 24 days so please address it from the way we view it the date of application to the date of award right right and and certainly that has come up at Oshkosh and comes up in other venues we we have indeed come quantum leaps in terms of more expeditiously processing medical certificates that have been deferred now you're probably aware that that just over 90% of all medical certificates are issued right out of the AME's office so 90% plus of the airmen leave their AME's office happy campers but there's another 10% that need that must be deferred to AMCD and we are victims of our own success where once we had medical conditions that we that we and everyone else considered uniformly disqualifying we now are willing to consider most anything short of a seizure disorder or bipolar disorder or psychosis I mean we work hard to get every airmen up that we possibly can and as such we get some pretty incredibly complex medical and and psychiatric request for medical certification so we're victims of our own success in order to keep up with this we convened sessions at CAME where we would bring in our regional flight surgeons that would would participate in what we call tiger teams where we'd all get together and work a couple of hundred cases in a week and now we have the capability to do that electronically with our database system and we have worked very closely training our regional flight surgeons where we have a have a have a great resource in in terms of working airmen certification cases electronically and it it does it does wax and wane with the number but we follow this closely that's an average number certainly the more complex the case the more likely you would be to have to wait longer for instance if you're an air transport pilot and you have a significant cardiac illness we convene a cardiology panel distinguished cardiologists from all over the country come to CAME every other month to look at all of the stress tests and the angiograms and all of the testing that we require so certainly by virtue of the fact that these folks have to wait for a panel they're going to be on the high end and i see richard wants to say something so i'll stop there and let you chime in richard i think it's important to appreciate in this arena of controversy obviously i'm the i'm the place i'm at the i'm the guy where the rubber hits the road i'm the guy that's making the making me these decisions um there are 400,000 exams coming to Oklahoma Oklahoma City and only a few a few of those actually require a deliberate process of careful medical consideration however i think the federal air surgeon doctor tilton and the deputy federal air surgeon doctor frazier deserve a great amount of credit in regards to this there's been significant initiatives being done to expedite this process one of which is the so-called quick cert program where it allows more and more delegated authority and this was something that ames and their pilots have been asking for for a long time the federal air surgeon has responded and dr tilton and dr frazier both involved in this process where more and more delegated authority is being allowed to get the ame in the process of doing the exams and helping with the certification the ames can also call us in Oklahoma City and get a verbal authorization to fly to delay this certification process to zero minutes in many cases so we in all seriousness are working very hard to make that wait just as reasonable as possible and with that ladies and gentlemen i think we've reached the end of our time i thank you very much for your attention