1. 45th Civil Aviation Medicine Forum
6th March 2018, Aviation House, Gatwick

2. 1 Welcome and Introductions
2 Apologies

3. 3 Approval of Agenda

4. 4 Approval of Minutes of Last Meeting
Amendments and corrections
Approval

5. 5 Matters arising and actions not covered in subsequent agenda items
Fatigue – availability and willingness of AMEs to support data gathering relayed to Head Flt Ops 22/1/18
Removal of limitations by AMEs – await new Medical IT system
Automated response set up
CAA Ref No in subject will become essential: new method of transmission of information using Huddle being introduced.
GDPR information for AMEs

6. 6 Medical Department Structure-update

7. 7 Medical IT System Replacement Project
Project on track for ‘Go Live’ by end March 2019 latest
‘Off-the-shelf’ solution requiring configuration but minimal bespoke development
Web-based solution, Cloud based data storage, access via CAA portal
Single applicant record – AMEs will see the same system as users at the CAA
GDPR compliant
Penultimate stage of supplier selection – 3 potential suppliers currently being evaluated
Decision on successful bid due mid-April
Subsequent work to include data migration, configuration, UAT and training

8. Records Management (AOB)
Electronic transmission of large files
Naming protocols for documents

9. EASA and Regulatory Activities

10. 8 Regulatory Activities / Information
EASA Standardisation
Audit Findings
EASA Rulemaking
Update of Part MED
Drugs and alcohol testing
Peer support programmes
EAMR
Age research
UK Exemption for Self Declaration

11. EASA Standardisation
UK CAA Participation in EASA Audits of other States
2017
TJ Switzerland
SE Denmark (cancelled)
2018
EH Netherlands
SM Greece
Full (Aircrew and ATCO) EASA MEST Inspection Audit July 2017

12. UK MEST Audit Findings & Actions (1)

13. UK MEST Audit Findings & Actions (2)

14. PART MED Changes PART MED Drugs and alcohol testing at initial Class 1
Comprehensive mental health assessment
Mental Health Section will be amalgamation of Psychology and Psychiatry
General
Tidying up of AME responsibilities around non-disclosure
Suspension and Revocation of certificates
Restructuring of text to remove general catch-all statements
Other: Thoracic aneurysms after surgery, CAD test
EAMR has been included in the Part MED changes

15. PART OPS Changes PART OPS Pilot support programme (National P-PAN)
Psychological ‘assessment’ pre-line training
Random drugs and alcohol testing

16. EAMR key points – Why? European Aero-Medical Repository
Recommended by Germanwings Taskforce: National Authorities to collaborate and exchange information
Pilots increasingly mobile- system designed to eliminate medical tourism
Reduces reliance on pilot self-declaration and reduce the risk of non availability of past medical history and assist with growing workload of medical certification.
Makes some key information available online even if current systems are paper based.

17. EAMR key points – What? Web based system - Class 1 pilots only
Currently 14 fields to be populated (6 basic fields, 8 medical certificate fields)
Each information change will be notified direct to the pilot by (helps data integrity)
Responsibility for the creation of initial record, and subsequently data entry, maintenance and quality lies with each NAA and its AMEs.
NAA and their AMEs will require access (currently gratis) and will require training (training material will be provided but delivery is NAA responsibility)
Unclear what the rate of data refresh at outset will be, target is real time.
European data protection issues have been taken into account by EASA

18. EAMR key points – When?
Entry into force with update of PART MED expected ‘mid 2018’
EASA expect full data capture to be complete in months. As each pilot is revalidated or recertified, then the initial record is created (UK - 25,500 records 12 month cycle)
Data capture will not involve historic data in Phase 1; no assurances on historic data given for phase 2
NAA engagement with the database likely to be audited (UK MEST Autumn 2018)
Interface with individual NAA IT systems not planned until phase 2 (requirements not yet written so timescales unknown)

19. EAMR – Risks and issues for CAA and AMEs
Resource impact to set up systems
Increased AME and MCT/medical SSC workload challenge
Running two databases side by side (MARS, EAMR) presents a data integrity risk
Diverse (European) AME community with vastly differing IT skills represents a real risk to compliance and data integrity
Phase 2 feeds from NAA systems likely to cause significant problems
Will need to be designed into oversight system and will require resource to monitor and oversee

20. EU Regulations and EASA Rulemaking
NPA Update of Parts ARA.MED and ORA.MED
RMT Regular update of Part MED
RMT Merging Parts MED and ATCO MED
EASA Age 60 Research Project
Vienna Age 60 Meeting

21. GA Medical Self-Declaration

25. GA Medical Self-declaration
Proposal by GA industry / stakeholders to extend self-declaration for Pilots flying EASA aircraft after 8th April 2018

26. Brief from Head of Medical Assessment

27. Chart showing files handled by Medical Assessors during the last 4 years. Summer 2017 handling more files than previous years but appears to show significant drop towards year end. ? Due to Cl 1 and 3 casework now being performed by AMEs.

28. Calls handled by the nurse specialists, also showing a drop towards the end of the year.

29. Files handled by the nurse specialists. Lower than previous years
Files handled by the nurse specialists. Lower than previous years. May be some issues with data Sept/Oct/Nov but doesn’t appear to show the same levels of drop as the Medical Assessors. Katherine Bradley looking into adjusting the way data is gathered to improve accuracy.

30. Class 1 and 3 Casework
Part MED and Part ATCO.MED have implementing rules that permit AMEs to make fit/unfit assessments and indicate which cases should be referred to the authority.
Already happening in other member states
Adjustments to MARS/AME On Line
Workshops in August/September 2017 for AMEs
-> e-Learning Platform training course
AMEs now able to make fit/unfit assessments on Class 1 and 3 cases following periods of unfitness and record these on MARS

31. Initial Class 1 OML
Issue around initial issue of a Class 1 medical certificate with OML.
IR currently states that OML can only be added to medical certificate of existing CPL/ATPL/MPL holder.
Recent case in media about initial applicant with HIV infection; current IRs/AMCs do not permit unrestricted certification with HIV.
CAA has submitted an Article 14(4) exemption to notify the EC of the issue of initial Class 1 medical certificates with OML whilst encouraging EASA to commission research to consider initial Class 1 with OML rule change.
CAA working with HIV specialists to consider mitigations for unrestricted certification

32. Insulin Treated Diabetes Mellitus
Currently 59 pilots across UK (52), Ireland (5), Austria (2) in protocol with certificates issued/soon to be issued.
Male 58
Female 1
Total 59
Average Age 44
Minimum Age 18
Maximum Age 75
Avge HbA1c 55
Min HbA1c 37
Max HbA1c 79
Diabetes Type
Type 1 45
Type 2 14

33. Guidance Material
Various documents requiring revision, partially revised, awaiting publication on website.
Recent activity:
Process document for producing and publishing guidance material
Collation of all material, stage of completion, authors etc
Central repository for developing material on CAA Sharepoint site

34. Brief From Head of Oversight and Training

35. Oversight
Team comprising Head of Oversight and Training, 3 auditors and 2 aeromedical support officers
Oversight of 4 AeMCs, 188 Active AMEs (129 UK Class 1, 29 UK Class 2, 30 overseas Class 1).
5 AMEs currently suspended (2.5%)
Approaching end of first 3 year audit cycle
90 site audits in 2017 (on target to meet EASA requirement)
Findings and observations at most audits (2-3 average)

36. Training
Extensive internal and external training to meet EU requirements
Support to AMEs (online training launched along with Class 1 and 3 casework seminars)
Delivery of lectures to national and international audiences
StR in Aviation and Space Medicine
Basic and Advanced Aviation medicine course contributions
Diploma in Aviation Medicine (teaching and examination support)

37. Brief From Head Aero medical Safety Systems and Emerging Technologies

38. Head of Aeromedical Safety Systems and Emerging Technologies
Overall Purpose
To act as the lead for Medical on aeromedical safety systems, compliance and risk management.
To provide expert advice on new technologies and innovations in Aviation and Space Medicine to the CAA and external stakeholders.
To systematise and oversee departmental research activities.
Other projects and pop-ups

39. Aeromedical Safety Systems, Compliance and Risk Management.
Set up Medical Safety Risk Panel
Systematise Safety Risk Data collection and reporting
Horizon Scanning
‘Pop-ups’
Balloon CAT review
GA medical self-declaration proposals

40. CAA regulatory SMS
Medical

41. For medical… Accident data (CAT and GA) Oversight data AAIB AME audits
THREAT and AAG
Other sources
Mandatory Occurrence Report Data
Aircrew (and ATCOs)
Other, RPAS(?), commercial balloons, FISO, RFFS, spaceplanes
Identify key risk areas and develop safety risk proformas where necessary
Oversight data
AME audits
AeMC audits
Case series/ by condition(s)

42. Medical Capability Team Research
Aim… Better coordination, visibility and reporting of work in progress
Data sources
developing more user-friendly MARS searches
S23 & data access
(Age project)
Discussion of new projects especially for trainees/students/interns etc
Systems
Statistical analysis
Ethics
Reporting & governance
Publications and Presentations

43. Safety Concerns and Issues from Members

44. Forthcoming Aviation and Space Medicine Events

45. Aviation & Space Medicine Meetings
AAME Leicester March 2018
ASMA Dallas May 2018
RAeS Spring lecture 24 May 2018 (provisional)
ECAM Prague September 2018
AMDA Aviation Health Conference September 2018
ICASM Bangkok November 2018

46. Any Other Business Items

47. Dates of Next Meetings
Thursday 13 September 2018 at 1400 hrs, Aviation House
Thursday 28 February 2019 at 1400 hrs, Aviation House