# Presentation: 336173

## Slide 1

## FAA AIR TRAFFIC CONTROLLER HEALTH PROGRAM

***Stephen W. Roberts, M.D., F.S.***
**Federal Aviation Administration **
**Aerospace Medicine Division, AWP-300**
**Western-Pacific Region**
**Los Angeles, California**

## OBJECTIVES

- Overview of the Air Traffic Control System in the U.S.
- Overview of the FAA's ATCS Health Program
- Review of Medical Standards
- Special Consideration Process – Waivers
- Drugs & Alcohol
- Other Conditions

## ATC in the U.S.

**ATC in the U.S.**

## FACILITIES

- _ARTCC_ – Air Route Traffic Control Center; 21 across the nation
- _AFSS_ – Automated Flight Service Station
- _TRACON_ - Terminal Radar Approach Control
- _ATCT_ – Air Traffic Control Tower
- _CERAP_ – Combined En-Route & Approach

## 2004

**Western Service Area**

**Central Service Area**

**Eastern Service Area**

## AIRPORTS

**Total number  - 18,770**
- Public - 5,352
- Private - 13,418

## U.S. AIRCRAFT 

**Air Carriers - 19,145**
- Jet - 7,270
- Turboprop - 3,740
- Piston - 5,757
- Rotorcraft - 2,378
**General Aviation - 204,700**

## AIR TRAFFIC ACTIVITYU.S. 

**AIR TRAFFIC ACTIVITY****U.S.**** **

**ARTCC - 44,936,000**
**ATCT - 54,574,000**
**TRACON - 51,294,000**
**AFSS - 33,831,000**

## TOTAL ATCS - U.S. 

**ATCT, ARTCC, TRACON, CERAP**
- WORKFORCE - 17,641
- ACTIVE - 17,201
-  **AFSS - 1 (Alaska)**

## ATCS SELECTION

- U.S. citizen
- At least a High School education
- 18 - 31 years of age
- Pass MMPI and physical exam
- Complete basic training - OKC, college, or via the military
- Final certification - OJT

## ATCS HEALTH PROGRAM

- Regulates all Aspects of the medical  certification of the ATCS _employed by the FAA_
- FAA Order 3930.3A (1980)
- Air Traffic Controllers not employed by FAA fall under Part 67
- Military has their own system

## RESPONSIBILITIES

- Dual oversight of program
- 1. Medical:
**Federal Air Surgeon*** – Sets national medical policy *
***Regional Flight Surgeon – ****Carries out FAS policy*
**Center Flight Surgeon*** *– *Oversees activity of medical field office*

## RESPONSIBILITIES

- 2. **Operational**
- Associate Administrator for Air Traffic Services
- Regional, Division Manager – coordinates with RFS on handling of cases
- Air Traffic Manager – Coordinates with RFS/FS in day-to-day operation of program

## PHYSICAL EXAMS

**Pre employment** – Form 8500-8, blood chemistry, drug test (No alcohol test),   16-PF (Psychological Screen)
**ARTCC/ATCT/TRACON/CERAP**
- <40 – Every 2 years; 40 or older, every year
**AFSS**
- <40 - Every 3 years; 40 or older, every 2 years

## MEDICAL CLEARANCE STATUS

**Qualified**
**Qualified with Special Consideration ** ( Waiver)
**Incapacitation **
- Temporary – short duration
- Permanent (Disqualifed)

## PHYSICAL STANDARDS

**PHYSICAL STANDARDS**

## ARTCC / TRACON / ATCT / CERAP
20/20 for near & far vision in each eye & with both eyes together

**20/20** for near & far vision in each eye & with both eyes together

**VISUAL ACUITY**

## COLOR VISION

**Pre employment only ...**
- _Normal_ – ISHIHARA, DVORINE, etc.
- Impact on future trends – Color screens, weather radar, etc.

## VISUAL FIELDS

**ARTCC / ATCT / TRACON / CERAP**
- Normal in both eyes; _Central_ (30 degrees from fixation point) & _Peripheral_ (>100 degrees  Horizontal & 140 degrees Vertical)
**AFSS **– Normal _central_ vision in at least one eye

## INTRAOCULAR PRESSURE

- Tonometry no longer required, general guidelines
- Pressure equal to Or <20 mm Hg
- Differences of 5 or less mm Hg between eyes
- Absence of pathology secondary to glaucoma or ocular hypertension

## PHORIAS

**ARTCC / ATCT / TRACON / CERAP**
- Must demonstrate visual fusion
**AFSS** – no double vision

## REFRACTIVE SURGERY

- Permitted as long as no permanent damage
- Halos, glare, variation in visual acuity, inflammation, infections, etc.
- Surgical report and current evaluation by eye specialist

## ENT

- Absence of illness or anomalies of the Ear – external, middle, inner
- Perforations, Tumors, Trauma, Chronic Infections, Neurologic, Problems, Meniere’s, Neuronitis, Vertigo
- Speech impediments

## AUDIOLOGY

- Audiometry does not show loss of more than 25dB at 500, 1000, 2000 Hz in better ear; worse ear may be no higher than 30 dB
- Loss of 40 dB in any ear may require an Otologic or Audiometric evaluation

## CARDIOLOGY

- Absence of:
- Symptomatic CAD (Angina, Infarct...)
- Valvular disease or replacement
- Congenital disease
- Surgery (CABG, Stent, Angioplasty...)
- Heart transplant
- Cardiomegaly
- Cardiomyopathy
- CHF

## EKG

**Required**:
- With pre employment examination
- Then at ages 40, 45, & 50
- Every 2 years after age 50
- As clinically indicated

## STRESS

**Difficult to assess**
**Multiple factors** – Family, Government, Society, Work, Self
**May be associated with Somatic complaints**

## OTHER CONDITIONS

**Neurology – **Seizures
**Pneumology – **Asthma, COPD
**Internal Medicine - **DM, HIV, GI
**Orthopedics -** Herniated Discs, Surgeries
**Urology – **Kidney Stones
**Psychiatry – **Depression, Anxiety, Medication

## SPECIAL CASES

**SPECIAL CASES**

## SPECIAL CONSIDERATION

**Waiver granted to permit an ATCS, who otherwise would be disqualified, to medically continue working**
- Fairly liberal policy, as long as safety is not impacted

## SPECIAL CONSIDERATION

- Employee bears the burden to show if they are fit to perform duties
- They also bear financial responsibility for any reports, tests, etc.

## DIABETES MELLITUS

**Condition must be well controlled**
- S.C. only if control is adequate
- Follow up every 3 - 6 months
**Absence of secondary complications**: CV, Renal, Neurologic, Ophthalmic, etc.

## DIABETES MELLITUS

**Control by diet and exercise, or by oral medication is acceptable**
**Fasting glucose < 150 mg% and normal  Hgb A****1****C (Less than 10.0)**
**Annual follow up if no problems**
- Reporting period may be extended on a case by case basis

## INSULIN & INSULIN PUMPS

**Is permitted in select cases**
**S.C. required and special follow up**
- Endocrinology report, EKG, Neurology,  Ophthalmology, CV
- Initially demonstrate 3 months of good control
- Annual evaluation
- Glucometer with memory

## CARDIOVASCULAR

**Considered for return to duty after 3 months of an event**
**No complications**
**Cardiovascular evaluation**
- Thallium Stress Test may be required
**Follow up every 3 to 6 months**
**Rx** – No adverse side effects

## CARDIOVASCULAR

**Angina**
- 3 month wait; symptoms resolved; no Rx
**Arrhythmias** – cause identified & treated; Rx permitted in select cases with S.C.
- Atrial fibrillation on anticoagulation will be considered on a case by case basis.

## HYPERTENSION

**HYPERTENSION**

**S.C. required if controlled with medication**
**Clinical report showing adequate control, EKG, annual follow up**
**Rx – most antihypertensive medications**

## BLOOD PRESSURE VALUES BY AGE

## PSYCHIATRY

**Depression and/or anxiety**
**Initially **– temporary incapacitation
**Recurrent**  - may permanently incapacitate Employee from work
**No psychotropic medication permitted**
**Any psychosis is incapacitating **
**Personality disorder**
- Repeated overt acts
**Substance abuse/dependence**

## DRUG AND ALCOHOL USE

**5 drugs** – Cocaine, Marijuana, Amphetamines, PCP, Opiates
**5 reasons to test**:
- Random
- Post- accident
- Reasonable suspicion
- Follow up/return to duty
- Pre-employment

## ALCOHOL AND DRUGS

**Rehabilitation**:
- 	-  **Management referral** – _**ONE **_** **opportunity  with a “Last Chance” agreement
- 	-  **If self referred** – _**TWO**_ opportunities;
- 	    2ND with “Last Chance”  agreement
- 	-  **Employee selects rehab program**,                   but _**agency must approve**_
- 	-**   Substance abuse evaluation**

## Upon successful completion of initial phase of treatment, ATCS may be returned to work
Wait 30 days
Negative return to duty  
    -Drug/Alcohol test
Aftercare for at least 12 months
Testing for drugs and alcohol done at discretion of RFS 

- Wait 30 days
- Negative return to duty
-     -Drug/Alcohol test
**Aftercare for at least 12 months**
- Testing for drugs and alcohol done at discretion of RFS

**ALCOHOL AND DRUGS**

## HIV

**Positive test does not disqualify**
**Anti-retroviral agents permitted with S.C.**
**AIDS, with adverse complications is disqualifying**

## CANCER

**Definitive diagnosis**
- Type, Stage, Etc.
**No Metastatic disease or complications**
**Chemotherapy not permitted**
- No MarinolTM
**Medical status reports; varies by Case**

## CONVULSIONS

**Epilepsy is permanently disqualifying **
**Explained Seizure – **Return to work once cause has been treated
**One unexplained Seizure **
- Wait 36 months
- No recurrence, no complications
- Rx not permitted
- Neurologic evaluation with follow-up reports

## LOSS OF CONSCIOUSNESS

**Cause identified and treated – **May return to work
**Unexplained:**
- Wait 12 months, each case is considered individually
- No residual findings
- Neurologic and CV Evaluations

## OFFICE OF AVIATION MEDICINE

## Slide 49