Medical certification of pilots with a disability

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Medical Certification of Pilots with a Disability


Types of Disability

The most common types of disability which prospective pilots present with are spinal cord injuries and amputations.  Other disabilities are assessed on an individual basis and the advice of the AMS should be sought.  See guidance in the ENT section on profound hearing loss.

Paraplegia – Fixed Wing Flying

Student pilots with paraplegia usually adapt quickly to the flying environment, but do need to use a hand controller to operate the rudder and fly an aircraft that is fitted with hand-operated brakes rather than toe operated brakes.  They also prefer to use low wing monoplanes, as the access to the cockpit on these aeroplanes is easier for a paraplegic pilot.  The most popular aircraft used by people with paraplegia are the PA28 series. 

Previously the UK CAA has approved several hand controllers such as:

  1. The Blackwood hand controller - it has the disadvantage that it requires a certified aircraft engineer to fit and remove the controller from the aircraft.
  2. The Visionair hand controller - this is a development of the Blackwood hand controller and has the advantage that it can be fitted and removed from an aircraft by the pilot and does not require the procedure to be signed off by a certified aircraft engineer.

EASA is the now the approving Authority and has already approved hand controllers for aerobatic aircraft.

Aeromedical considerations include the use of muscle relaxants which have significant Central Nervous System side effects, analgesics (often opioid based) and bladder control medication, including the anticholinergic and tricyclic groups.  Unfortunately most of these medications are unacceptable for certification and applicants will need either to stop these medications or not take them for a suitable period before flying, in order to hold a valid certificate.  Sometimes, on stopping the muscle spasm relieving drugs, individuals with paraplegia develop significant muscle spasm and clonus which may represent a significant inflight safety hazard. 

Paraplegia – Rotary Flying

Thus far the UK CAA has not certificated a paraplegic helicopter pilot and there is currently no EASA approved hand controller to operate the yaw controller on helicopters.


Amputees

Upper limb

Single upper limb amputations usually represent little problem for certification.  Pilots often use a prosthesis which can be clamped to the yoke and in general the prosthesis does not need to be certificated by the CAA, providing that failure of the prosthesis (e.g. falling off the stump) would not result in the pilot losing complete control of the aircraft.  In the case of double upper limb amputees, the prostheses need to be certified by EASA to ensure that they are manufactured to the same standard as aircraft parts.  In this circumstance they are considered as part of the aircraft control system.
 

Lower limb

Bilateral lower limb amputees will usually require an approved hand controller whereas single lower limb amputees usually do not.  Below knee amputees, usually wear their prosthesis and operate the rudder and toe brake controls with their prosthetic leg.  A fixed ankle prosthesis is generally preferred by pilots rather than an articulated ankle which tends to make fine rudder and brake inputs somewhat difficult.

Above knee amputees generally do not wear their prosthesis whilst flying and can operate the rudder either by means of a toe-strap being fitted to the rudder pedal which is operated by the remaining leg, or the so-called “dancing” technique.  This technique was first developed in America and utilises the remaining leg to control both rudder pedals by swiftly transferring the foot from the right to left rudder peddle.  Initially, there were some concerns that in an “on limits” cross wind landing, this would compromise flight safety, but it is now felt that it is an acceptable technique.

Aeromedical concerns with amputees

The main issue with amputees is phantom limb pain which is often treated with carbamazepine.  Unfortunately due to its side effect profile, it is not an acceptable medication for aviators.

 

Hand injuries

Many pilots with hand injuries or deformities have devices manufactured which enable them to operate controls which their own hands could not operate.  An example of this is a pilot with very severe rheumatoid hands who uses a specially manufactured device to operate the fuel flow control.  A medical certificate may be issued with a limitation that requires the pilot to carry this device at all times. 

Class 2 Certification Procedure

An applicant with a disability can attend an Aeromedical Examiner (AME) for a medical examination.  In consultation with the Authority Medical Section a Class 2 medical certificate may be issued with a safety pilot limitation (OSL) and any other appropriate limitations providing the examination is satisfactory in all other respects, apart from the disability.  Once the student pilot’s instructor feels that the pilot is ready to go solo, the pilot can undertake a Medical Flight Test (MFT) with a Flying Instructor Examiner (FIE).  The form for this is available on the CAA website.  The test should include an assessment of the ability of the pilot to evacuate an aircraft in an emergency.  The MFT form should be submitted to the AME and if satisfactory, the AME should reissue the Class 2 medical certificate with the safety pilot limitation removed, in consultation with the Authority Medical Section (AMS).  This will allow the pilot to continue his flying training, which can include solo flying.  Sometimes the pilot is limited to demonstrated aircraft types only and, therefore, the “OAL” limitation should be added to the medical certificate.  Additional types can be added by a check ride with a Chief Flying Instructor (CFI) following which the CFI signs the pilot’s logbook, stating that the pilot can safely fly the additional aircraft type.


Professional Flying

Pilots with disabilities who wish to fly professionally will need to undertake an initial Class 1 medical at an Aeromedical Centre (AeMC), as is the case for all Class 1 applicants.  An MFT is likely to be required (as above) with the report submitted to the AeMC who will refer the applicant to the AMS.  During the MFT the applicant will be required to demonstrate that they can assist passengers with emergency egress from an aircraft.

 

Useful Contacts:

Flying Scholarships for the Disabled - http://www.fsfdp.org.uk

Aerobility - http://www.bdfa.net