AOPA Turbine Pilot Magazine - April 2019 - 120

NEWS & NOTES
MEDICALLY SPEAKING

PILOT PROTECTION SERVICES

A bump on
the noggin

Head injuries and
medical certification
THE ONLINE MEDXPRESS medical application, used by all of us who periodically apply
for an FAA medical certificate, includes a
section that asks about any history of medical conditions. Several of those items can
be tied to things that happen "behind our
faces and above our throats," as the band
Twenty One Pilots might say. "Frequent or
severe headaches," "dizziness or fainting
spells," "unconsciousness for any reason,"
and "neurological disorders; epilepsy, seizures, stroke, paralysis, etc." are conditions
that will attract your AME's attention, and
ultimately the FAA's as well.
In the world of aerospace medicine,
two organ systems are high on the list
that keeps the regulators on their game.
Cardiovascular and neurological pathology represent the failure points that
produce some of the highest risk for medical impairment and incapacitation.
Head trauma is scary because sometimes a bump on the head that causes a big
goose egg, a bruise, a little blood, and a mild
headache at the time of the injury could be

BY GARY CRUMP

Pilot Protection
Services

harboring a much more serious problem a
few days or weeks down the road.
Already in 2019, I have spoken with
two AOPA members who suffered what
appeared to be "mild" head injuries-one
from a short fall off a ladder while cleaning roof gutters and another from a fall
while bike riding. Neither lost consciousness for more than a few seconds (the
time they were "seeing stars" immediately
after the incidents). Within days after
those injuries, both went to the emergency department with headaches and
cognitive deficits. Imaging studies determined that they had both experienced
intracranial bleeds secondary, probably, to the previous head trauma. One
required surgery to take care of a small
blood clot, a subdural hematoma, and the
other recovered without the need for surgical intervention.
Several factors play into the certification decision making once the FAA
sees a history of head injuries on the
MedXpress application. Concerns about

personality changes; neurocognitive
performance deterioration; persistent post-traumatic or post-concussion
symptoms that can result in severe headaches, vomiting, spatial disorientation,
or altered sleep patterns; and post-event
seizure or epilepsy are at the forefront of
the risk assessment process.
Traumatic brain injury is generally
classified as mild, moderate, or severe.
Duration of loss of consciousness or
alteration of consciousness, presence
and duration of post-traumatic amnesia,
presence or absence of skull fracture,
and brain contusions and/or free blood
in the brain (intracranial bleeding) can
determine how long a recovery period
is required before a pilot could be considered safe to fly. At the low end of
the scale, a mild head injury with short
duration symptoms could still require a
six-month grounding. For someone with
a severe head injury, a no-fly period of up
to five years is the policy. In most cases,
neurocognitive testing will be required
to determine the presence of any postevent deficits.
GARY CRUMP is the director of medical

certification for AOPA's Pilot Information
Center.

www.aopa.org/pps

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120 | AOPA PILOT April 2019

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AOPA Turbine Pilot Magazine - April 2019

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