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## FAA TRAINING PROGRAMS IN AVIATION MEDICINE

## Aerospace Medical Education Division

## Civil Aerospace Medical Institute

## FAA Office of Aerospace Medicine

The Aerospace Medical Education Division of the Civil Aerospace Medical
Institute (CAMI) offers several aeromedical training programs for
Aviation Medical Examiners (AMEs), civil aviation pilots, and others in
the civil aviation community. These training programs include: Basic
Aviation Medical Examiner Seminars, Theme Aviation Medical Examiner
Seminars, Multimedia Aviation Medical Examiner Refresher Course
(MAMERC), Clinical Aerospace Physiology Review for Aviation Medical
Examiners Course (CAPAME), Aviation Physiology Courses, Global Survival
Courses, and the FAA International Exchange Visitor Program.

**[AVIATION MEDICAL EXAMINER TRAINING PROGRAMS]{.underline}**

The Federal Aviation Administration has a voluntary force of
approximately 4,700 physicians designated to perform duties as Aviation
Medical Examiners (AMEs). These AMEs are located in the private sector,
Federal agencies (Air Force, Navy, Army, NASA, Coast Guard, others) and
in 97 countries around the world. AMEs are given authority to perform
physical examinations of U.S. airmen to determine their qualifications
for the issuance of a medical certificate as required under Part 67 of
the Code of Federal Regulations. In addition to providing an essential
service to the aviation population, AMEs have the responsibility to
ensure that only those applicants who are physically and mentally fit to
perform flying duties safely will be issued medical certification. To
properly discharge the duties associated with this responsibility, AMEs
must have detailed knowledge and understanding of the FAA rules,
regulations, policies, and procedures related to the medical standards
and the certification process.

***Basic Aviation Medical Examiner Seminar***

This one-week seminar is offered 3-4 times per year at the FAA Civil
Aerospace Medical Institute (CAMI) in Oklahoma City, Oklahoma.
Completion of this seminar is one of the mandatory requirements for
designation as an AME for the FAA. This seminar is designed to:
Familiarize new AMEs with the FAA medical certification program and
their responsibilities in this program. Recognize the basis for
disqualification of an airman with a medical problem and the conditions
necessitating deferral or denial as outlined in Federal Aviation
Regulations. Understand and be able to explain to an airman the denial
process to include steps necessary for certification appeal rights.
Enable AMEs to become the local authority in aviation medicine, and as a
resource to assist medical colleagues in determining who may be able to
fly safely as a patient or airman. This seminar complies with ICAO
International Standards on Personnel Licensing, Annex 1 to the
Convention on International Aviation, No. 1.2.4.4. \"Contracting states
shall designate medical examiners, qualified and licensed in the
practice of medicine, to conduct medical examinations of fitness of
applicants for the issue or renewal of the licenses or ratings\...\",
and No. 1.2.4.4.1 \"Medical examiners shall have had, or shall receive,
training in aviation medicine...\"

***Medical Certification Standards and Procedures Training (MCSPT)***

Completion of this training is one of the mandatory requirements for
designation as an AME for the FAA. AME applicants must complete this
training as a pre-requisite for attendance to a Basic AME Seminar. A
staff member from the AME\'s office is also required to complete this
training prior to the AME\'s designation and subsequently every 3 years.
MCSPT is a computer-based course (also available in correspondence
version) that was designed to familiarize AMEs and their staffs with the
administrative aspects of the medical certification program, and to
prevent/reduce AME errors in the processing of medical certification
documentation that are time-consuming and costly to the FAA.

***Theme Aviation Medical Examiner Seminars***

To maintain their designation, AMEs are required to complete refresher
training every 3 years. One alternative to comply with this training
requirement is to attend a 2 ½ day theme AME seminar. The seminars are
offered in 6 different locations across the U.S. every year. The first
day of the seminar is completely devoted to a particular medical theme.
Available themes are: 1) Cardiology, 2) Neurology, Neuropsychology, and
Psychiatry, 3) Ophthalmology, ENT, and Endocrinology and 4) Aviation
Physiology and Human Factors. These seminars are designed to provide the
latest medical and technical information and clinical techniques in
various medical fields and specialties, to improve the proficiency of
AMEs in their medical practice. Improve the AME\'s knowledge, techniques
and skills in medically evaluating airmen. This is accomplished by
instructing AMEs in those medical specialties and behavioral sciences
that will enable them to assess the airman\'s ability to operate an
aircraft with maximum mental and physical proficiency.

***Multimedia Aviation Medical Examiner Refresher Course (MAMERC)***

Another option to comply with the mandatory AME refresher training
requirement is to complete MAMERC. This course can be used as a
substitute for Theme AME Seminar attendance on alternate 3-year cycles,
which extends the time between seminar attendance to 6 years and reduces
AME travel expenses and time away from the office. The MAMERC is a
computer-based training course (also available in correspondence
version) designed to evaluate and enhance the quality of airman medical
certification decisions made by AMEs. The MAMERC evaluates, instructs,
and tests AMEs on their knowledge of medical certification standards and
how they apply such knowledge to make appropriate aeromedical
certification decisions. For the first time in the history of the FAA
AME program a training course was designed to evaluate, instruct, and
test AMEs on their medical decision-making skills regarding airmen
fitness to fly. AMEs not only have to demonstrate their knowledge of
medical certification standards, but how they apply such knowledge to
make appropriate aeromedical certification decisions. The course
includes a videotape containing 30 scenarios that portray AMEs,
Aerospace Medical Certification Division personnel, Regional Flight
Surgeons, and consulting physicians performing their various duties in
the airman medical certification process. After viewing each scenario,
AMEs are required to complete a pre-test that evaluates their knowledge
of medical certification standards and their aeromedical decision-making
skills. Those AMEs who successfully complete the pre-test may reduce
total training time to three or four hours. AMEs who are not as
proficient are provided with a more detailed, self-paced, interactive
instruction designed for maximum learning efficiency. Furthermore, the
MAMERC provides an effective quality assurance and quality improvement
tool for the Aerospace Medical Certification Program.

***Clinical Aerospace Physiology Review for Aviation Medical Examiners
Course (CAPAME)***

This computer-based course (also available in correspondence version)
was designed to enable AMEs to recognize the hazards of pilot exposure
to self-imposed and environmental stress factors during the operation of
an aircraft, that may lead to impairment, incapacitation, or death. This
course familiarizes AMEs with the physiological effects resulting from
the interaction between humans, the aerospace physical environment, and
the aircraft. The objective of this course is to enable AMEs to
recognize unsafe conditions and/or practices during the operation of an
aircraft that may lead to the physiological impairment and/or
incapacitation of pilots. AMEs can increase their knowledge of aerospace
physiology and improve their ability to assist airmen who experience
aviation-related medical problems. In addition, AMEs must possess the
necessary knowledge in aerospace physiology to provide appropriate
advice to civil aviation pilots regarding the impact of these
aviation-related stress factors. The course includes a videotape with 30
scenarios portraying airmen who have been affected by a variety of
problems including hypoxia, hyperventilation, decompression sickness,
trapped gases, acceleration exposure, noise exposure, vibration
exposure, laser exposure, spatial disorientation, airsickness, carbon
monoxide poisoning, heat stress, self-imposed stress, etc. After viewing
each scenario, AMEs are required to complete a pre-test that evaluates
their knowledge of medical certification standards and their aeromedical
decision-making skills.

***Advanced Aerospace Medicine Multimedia Course (AAMMC)***

Aerospace medicine is a very dynamic scientific discipline that must
keep pace with not only the rapid advances in medicine in general, but
also unique aerospace medical issues resulting from the accelerated
introduction of new aerospace technologies. Maintaining currency in
civil aerospace medicine presents a challenge for all physicians who are
involved in the day-to-day operational aeromedical support of civil
aviation. FAA physicians as well as AMEs are the target populations for
this new multimedia course that is currently under development. However,
this course will me made available to anybody who is interested.

**[AIRMEN TRAINING PROGRAMS]{.underline}**

Airmen training programs are designed to promote aeromedical knowledge
and safety among the approximately 620,000 civil aviation pilots in the
U.S.

##### Aviation Physiology Course

Physiological training for pilots was introduced in the military in 1942
to prevent and/or reduce the number of incidents, accidents, and
fatalities resulting from pilot exposure to the hostile environmental
conditions encountered during flight.

Pilots who are knowledgeable about aeromedical facts are certainly
better prepared to deal with unexpected and/or expected inflight events
such as: 1) loss of cabin pressure (slow or rapid) leading to hypoxia,
trapped gas problems, or decompression sickness, 2) exposure to an
unfamiliar motion environment leading to spatial disorientation, 3)
exposure to acceleration forces (Gs) leading to gray-out, black-out, or
even unconsciousness (G-LOC), 4) exposure to noise, vibration, or
thermal stress leading to impaired performance, and 5) exposure to
self-imposed stresses which may lead to, and/or aggravate, any of the
above mentioned inflight events.

The U.S. Code of Federal Regulations (CFR), Title 14, Part 61.31
(f)(2)(i), indicates that no person may act as pilot in command of a
pressurized airplane that has a service ceiling or maximum operating
altitude, whichever is lower, above 25,000 feet MSL unless that person
has completed ground training that includes instruction on respiration;
effects, symptoms, and causes of hypoxia and any other high altitude
sicknesses; duration of consciousness without supplemental oxygen;
effects of prolonged usage of supplemental oxygen; causes and effects of
gas expansion and gas bubble formations; preventive measures for
eliminating gas expansion, gas bubble formations, and high altitude
sicknesses; physical phenomena and incidents of decompression; and any
other physiological aspects of high altitude flight.

The objective of the FAA Aviation Physiology Course is to familiarize
pilots with the physiological and psychological stresses of flight
including the effects of self-imposed stress (illegal and legal drug
use, alcohol consumption, smoking, fatigue, inadequate nutrition,
sedentary lifestyle, excessive caffeine consumption, etc.) and their
impact on aviation safety.

This course includes practical demonstrations of rapid decompression (8
to 18K feet), hypoxia (25K feet), and night vision, using the safest and
most technologically advanced training altitude chamber (Fig. 1)
available in the U.S. today.

![](media/image2.jpeg){width="3.152083333333333in"
height="2.5256944444444445in"}

Figure 1. Altitude Chamber

CAMI has the only operational altitude chambers (training and research)
in the U.S. that meet the current safety standards in the pressure
vessel industry to ensure the protection of occupants, operators, and
maintenance staff. This requires that the design, fabrication, testing,
and inspections of the chamber meet the following standards: 1) American
Society of Mechanical Engineers, (ASME) ASME/ANSI, PVHO-1 \"Safety
Standards for Pressure Vessels for Human Occupancy\", 2) ASME, \"Boiler
and Pressure Vessel Code\". Section VIII, Division I, \"Rules for
Construction of Pressure Vessels\", Section II, \"Material
Specifications\", and Section IX, \"Welding and Brazing
Qualifications\", 3) National Fire Protection Association, (NFPA), 70,
National Electrical Code, (NEC) National Fire Protection Association,
(NFPA), 99B, Hypobaric Facilities.

The Aviation Physiology Course also includes a practical demonstration
of spatial disorientation using a General Aviation Spatial
Disorientation Demonstrator (GYRO) or the Virtual Reality Spatial
Disorientation Demonstrator (VRSDD). The critical importance of this
type of practical demonstration is evidenced by aircraft accident
investigation reports indicating that inflight spatial disorientation is
a causal or contributing factor in about 10% of all general aviation
accidents. Furthermore, it has been reported that up to 90% of the total
number of general aviation accidents involving inflight spatial
disorientation are fatal.

The GYRO (Fig. 12) is a device that provides 360 degree continuous yaw
motion as well as + or - 15 degree pitch and 30 degree roll which, in
conjunction with a computerized imaging system, results in a realistic
simulation of flight. The GYRO provides civil aviation pilots, aviation
medical examiners, and FAA flight crews with the opportunity to
experience vestibular and visual illusions (spatial disorientation) that
occur during IFR conditions in an inherently safe environment. The
programmed flight in the GYRO does not require an instructor - only an
external safety observer. The pilot receives a 2-min orientation and
then takes the controls. The 6-min. flight progresses from VFR, with
\"out-the-window\" scenes on a CRT, to IFR conditions.

![](media/image3.jpeg){width="3.1944444444444446in"
height="2.915277777777778in"}

Figure 2. GYRO

The VRSDD (Fig. 3) is a one-of-a-kind prototype that uses a powerful
computer with terrain and aircraft database and a Head Mounted Display
(HMD). This visual system is coupled with a 360 degree continuous yaw
motion-platform and allows for a very realistic demonstration of the
effects of spatial disorientation during flight. The key difference
between the VRSDD and other spatial disorientation devices is that it
immerses the pilot in a real time 3-dimensional space. The VRSDD
utilizes high resolution 3-dimensional imagery to create a flight
environment which is "virtually" real. The user has a real time
interaction with the virtual environment by becoming part of it and by
being able to manipulate/control it. Virtual reality is an effective,
efficient, and inherently safe technology that can be used to simulate
logistically impractical, expensive, or even dangerous real world
settings (i.e., aviation and space environments, medical procedures,
etc.).

![](media/image4.jpeg){width="3.152083333333333in"
height="2.9034722222222222in"}

Figure 3. VRSDD

The VRSDD is being used by civil aviation pilots, aviation medical
examiners, and FAA flight crews participating in Aviation Physiology
training courses offered at CAMI. It is also being used in support of
the National Accident Prevention Program throughout the U.S. It provides
civil aviation pilots with the opportunity to experience, in an
inherently safe environment, certain vestibular illusions that occur
during IFR conditions. The VRSDD provides a practical and highly
convincing demonstration of the human limitations to maintain spatial
orientation during IFR conditions, as well as emphasizing the importance
of relying on cockpit instrumentation to safely fly under these
conditions. This device provides the practical means to convince VFR
rated pilots to stay out of IFR conditions, and increases awareness
among IFR rated pilots that they are not impervious to the effects of
spatial disorientation simply because they hold an IFR rating.

##### Global Survival Course

The Global Survival Course provides the necessary knowledge and skills
for coping with various common survival scenarios including desert,
arctic, and water environments following an emergency aircraft landing,
ditching, or a crash. Practice sessions are conducted using a thermal
chamber, a ditching tank, and an emergency evacuation aircraft
simulator. In addition, this course teaches how to easily assemble and
use a personal survival kit.

![](media/image5.png){width="3.2in" height="2.4in"}

Fire Starting Demonstration

The thermal chamber (Fig. 4) is used to practice survival techniques and
procedures in a cold (-20°F), windy (15-20 mph), and dark (simulated
night) environment.

![](media/image6.jpeg){width="3.152083333333333in" height="2.30625in"}

Figure 4. Thermal Chamber

The ditching tank (Fig. 5) is used to practice techniques and procedures
for emergency egress from a Cessna Sabreliner or a Beechcraft King Air;
as well as water survival techniques, the use of flotation devices, and
rescue procedures (using a helicopter hoist). The water temperature in
the ditching tank is maintained around 80 °F.

![](media/image7.jpeg){width="3.1569444444444446in"
height="2.529861111111111in"}

![](media/image8.jpeg){width="3.142361111111111in"
height="2.321527777777778in"}

![](media/image9.png){width="3.1381944444444443in"
height="2.3534722222222224in"}

Figure 5. Ditching Tank

The emergency evacuation simulator (Fig. 6) consists of a section of
fuselage of a passenger aircraft that is elevated (using hydraulic
jacks) and then filled with non-toxic smoke (glycerin) to provide a
practical and very realistic simulation of an emergency evacuation
scenario due to smoke in the cabin.

![](media/image10.jpeg){width="3.1625in" height="4.74375in"}

Figure 6. Emergency Evacuation Simulator

##### Aviation Physiology Video Course

The objective of this course is to familiarize civil aviation pilots
with the physiological effects of exposure to flight stress factors and
self-imposed stress, as well as the appropriate preventive and/or
protective measures. This distance education course can be made
available to every civil aviation pilot who requests a copy, and to
anybody else interested in the promotion of aviation safety. Topics
covered in this video course include: physics of the atmosphere,
respiration and circulation, hypoxia, hyperventilation, trapped gases,
decompression sickness, oxygen equipment, cabin pressurization, motion
sickness, fitness for flight, spatial disorientation, self imposed
stress, thermal stress, fatigue, vision in aviation, noise and
vibration, acceleration exposure. The first part of this video course is
nearing completion.

##### Global Survival Video Course

The objective of this course is to familiarize civil aviation pilots
with the basic survival methods and techniques to increase their chances
of survival following an emergency aircraft landing, ditching, or a
crash. Topics covered in this video course include: will to survive,
cold land survival, hot land survival, water survival, jungle survival,
survival medicine, survival signaling, survival kits.

##### Human Factors in General Aviation Operations Video Course

This video course is under development.

**[OTHER AEROMEDICAL EDUCATION SERVICES]{.underline}**

##### International Outreach Program

#### 

##### CAMI supports foreign requests for assistance in civil aviation medicine and aviation human factors. The support provided includes: participating in the design, development, implementation and/or evaluation of international training activities in aviation medicine; presenting formal lectures; facilitating discussions; and providing technical advise and information. These international activities help promote aviation safety by discussing FAA medical standards, policies, and procedures with professionals in foreign countries who are involved in the organization and development of their own civil aviation programs.

##### 

##### FAA International Exchange Visitor Program

#### 

The FAA Civil Aerospace Medical Institute supports international
programs that promote interaction between aviation medicine
professionals, enable exchange of scientific information, and promote
FAA\'s leading role in civil aviation medicine worldwide.

One such program is the International Exchange Visitor Program which
allows qualified specialists from foreign civil aviation organizations
to enter the U.S. to conduct studies and/or exchange information and
expertise at FAA facilities and at a minimum cost to the agency. The
main objective of this program is to promote global aviation safety
through international cooperation activities, promotion of FAA policies
and procedures and of U.S. standards and equipment, and avoidance of
unnecessary duplication of research efforts.

Participants in this program: 1) learn the functions and
responsibilities of the FAA Office of Aerospace Medicine as they relate
to the promotion of aerospace safety, 2) participate in the day-to-day
work activities at CAMI, 3) share their specialized knowledge and skills
with FAA\'s specialists in support of various operational programs, and
4) receive the benefits of interacting with FAA professional and
technical personnel at a leading civil aerospace medicine institute

##### Aeromedical Publications

High quality publications are produced to fulfill the diverse
aeromedical information needs of FAA personnel, AMEs, civil aviation
pilots, pilot schools, and others in the civil aviation community
interested in the promotion of safety.

The Federal Air Surgeon\'s Medical Bulletin is a quarterly publication
that features the following sections: 1) The Federal Air Surgeon's
Column - Updates on Office of Aerospace Medicine\'s programs, goals,
objectives, policies, and procedures as articulated by the Federal Air
Surgeon, 2) Aeromedical Certification Cases - Discussion of special
aeromedical certification cases involving pilots or air traffic
controllers, 3) Aviation Medicine Research Update - Description of
aerospace medical and human factors research accomplishments of
relevance to aviation safety, 4) Incapacitated Pilot Tales - Discussion
of actual pilot incapacitation\'s, the outcomes, and the lessons
learned. Description of civil aviation incidents and accidents where
pilot incapacitation/impaired performance played a significant role in
the occurrence of such events, 5) Aviation Medical Examiner Program
News - AME education programs updates. Profiles of AMEs and their
accomplishments in support of the civil aviation community. Letters and
articles from AMEs (opinions, suggestions, experiences, etc.). Updates
on the administrative aspects of the AME program, 6) Aviation Physiology
Update - Discussion of aerospace physiology and human factors issues
that have an impact on civil aviation operations, 7) Office of Aviation
Medicine News - Relevant news items from the perspective of AAM
personnel from headquarters, regions, centers, and the Civil Aerospace
Medical Institute, and 8) Meetings Calendar - Information about upcoming
national and international scientific events (conferences, meetings,
symposia, courses, etc.) in the field of aviation medicine and its
allied disciplines.

Medical Facts for Pilots are short brochures designed to provide
essential information to civil aviation pilots regarding potential
aeromedical hazards, and how to prevent or cope with them to ensure
flight safety. Currently available titles include: Alcohol and Flying,
Altitude Decompression Sickness, Spatial Disorientation, Hearing and
Noise in Aviation, Hypoxia, Laser Eye Surgery, Over The Counter
Medications and Flying, Pilot Vision, Seat Belts and Shoulder Harnesses,
Smoke, Sunglasses for Pilots, Deep Vein Thrombosis and Travel, and
Carbon Monoxide a Deadly Menace.

FAA Office of Aerospace Medicine Technical Reports are publications used
to disseminate the results of aerospace medical and human factors
research conducted by the FAA Office of Aerospace Medicine. To date
1,022 technical reports have been published on a wide range of subjects
from Angular Acceleration to Workload Effects on Complex Performance.

##### Aeromedical Library Services

CAMI has one of the best libraries in the world specialized in aviation
medicine and human factors. Library services to CAMI and Office of
Aerospace Medicine patrons include 1) interlibrary loans through
membership in two automated networks that provide access to the
collections of approximately 29,000 participating libraries; 2)
literature searches using numerous online databases and CD-ROM products;
3) reference services; 4) table-of-contents service from 200+ hardcopy
journals and electronic sources; and 5) acquisition and cataloging of
books, journals, and other types of information materials. The special
collection, which focuses on aviation medicine and aviation human
factors, is networked with several other libraries so that the unique
materials may be shared. These materials include 6,500 books, 200+
current journal titles, 13,000 cataloged technical reports, a basic
reference collection, multimedia CBI programs, and numerous CD-ROM
titles.

For additional information about any of the above mentioned training
programs and services please contact:

Richard F. Jones, M.D.\
Manager, Aerospace Medical Education Division

Civil Aerospace Medical Institute\
FAA, MMAC, CAMI, AAM-400,

P.O. Box 25082\
Oklahoma City, Oklahoma 73125-9944\
Phone #: (405) 954-4832

FAX #: (405) 954-8016

e-mail: richard.f.jones@faa.gov