Pilot Cardiac Evaluation For Fitness for Duty

In many jurisdictions, including the United States, an annual medical incapacitation risk of one percent per annum in 2-pilot public transportation is used in assessing pilot fitness to fly for many medical conditions. This rule is the one percent rule and is applied in evaluating pilot cardiovascular fitness to fly. When a cardiovascular issue is identified, the Federal Aviation Administration (FAA) may require a cardiovascular evaluation for aircrew. This assessment should be performed within 90 days. It should include a personal and family medical history, a clinical cardiac and general physical examination, and an evaluation and statement regarding the applicant's medication. Furthermore, it should include an evaluation of functional capacity and modifiable cardiovascular risk factors, a prognosis for incapacitation, and blood chemistry (fasting blood sugar and current blood lipid profile to include total cholesterol, high-density lipoprotein [HDL], low-density lipoprotein [LDL], and triglycerides). Depending on a pilot's age and medical certificate class, most jurisdictions typically require a resting 12-lead echocardiogram (ECG) for initial license application and routine medical surveillance of aircrew. For example, the FAA requires an ECG for first-class medical applicants on the first application after the 35th birthday and annually after the 40th birthday. ECG findings for the aircrew population in military and civilian aviation are somewhat inexplicable, especially for aircrews younger than 30. Boos CJ et al investigated abnormalities in medically screened ECGs of 868 healthy military aircrews with an average age of 39.6 years. In 46.3% of the ECGs, results were classified as normal; however, 53.7% were classified as abnormal. Common training-related ECG findings were sinus bradycardia, first-degree atrioventricular block, and incomplete right bundle branch block. These findings are considered normal variance in young, healthy aircrew, and further investigations are not required. Hampton JR reports that minor abnormalities of the ST-segment and T-wave are seen in one percent of the normal population. In epidemiological studies, these findings are associated with an increased risk of death, and such findings in aircrew during medical assessments for fitness need to be investigated further with a stress test, especially in aviators older than 35 years old. Abnormal ECG findings of aircrew should always be compared with previous ECGs before making aeromedical decisions.