Part 2: Germanwings Crash Lessons - Medical Detection

Physician's Legal Duty to Detect and Report Pilot Medical Problems

Apr 4, 2015

by John Ogle, MD, MPH, FACEP

Commercial Pilot / USAF Flight Surgeon


The Germanwings crash series examines aircraft-assisted homicide from an aviation medicine perspective. When and how should national or international "systems" detect unstable pilots and deny them access to public airspace? Aviation Medical Examiners have legal and ethical duties to screen aviators for medical issues. Flight examiners verify piloting competency. Both flight and medical examiners independently test pilot mental stability.

Overview: Medical and Legal Duties to Screen Commercial Pilots for Health Problems

Most commercial aviators remain competent and professional throughout their careers, but Flight 9525 has prompted review of health monitoring strategies for pilots. The previous article (Part 1) in our Germanwings crash series highlighted the rare but dramatic problem of aircraft-assisted homicide. This part covers medical screening in general; future segments will focus on psychological screening in particular.

Pilot Screening Question

How can the public know that commercial pilots are fit to fly?

Short Answer: It is not possible for any entity to guarantee 100% future fitness for all pilots; however, history shows that the multi-dimensional aerospace medical system is incredibly robust.

Flying is a Privilege not a Right

Similar to driving on public roads, flying in public airspace is a privilege not a right. The public accepts the general authority of the FAA to control access to the skies. In the criminal justice system individuals are innocent until proven guilty, but in the national airspace system, pilots must prove their medical and practical competence to fly.

Continuous Aviation Screening

Repeat examinations are a reality for aviators. Pilot candidates seeking to maintain licensure and flight privileges must pass recurring flight physicals by medical examiners (AMEs) throughout their careers. Additionally, the pilot must past recurring practical check rides from flight examiners.

Medical Exam vs Practical Flight Exam

Flight physicals are a filter to identify obvious defects and psychological instability that might present a danger to flight. Conversely, pilot skills are evaluated through practical competency tests like the flight review (formally the biennial flight review or BFR). The exam distinction is confusing to non-aviators. AMEs conduct flight physicals and flight examiners conduct FAA reviews and check rides. Flight physicals give no indication of aviation skill, and practical flight tests disclose little direct information about medical status. With the rare exception of medical flight tests, there is minimal overlap between medical and practical evaluation. Importantly, mental status and psychological stability are assessed in both settings.

Legal Authority for Pilot Medical Exams

Screening policy begins with law. Laws differ slightly from country to country, but aviation medicine is well codified in the United States:

Title 49, United States Code (U.S.C.) (Transportation), sections 109(9), 40113(a), 44701-44703, and 44709 (1994)...authorizes the FAA Administrator to delegate to qualified private persons...authority to examine applicants for airman medical certificates and to issue or deny issuance of certificates.
Source: FAA Guide for Aviation Medical Examiners, 2015.

Aeromedical Certification for US Pilots

In the U.S., pilots demonstrate their medical fitness through a network of over 3000 specially trained private physicians called Aviation Medical Examiners (AMEs). These FAA designated doctors are located domestically in all 50 states and internationally in 89 other countries. They perform 450,000 annual flight physicals. Airmen medical data are transmitted, processed and safeguarded in a central repository in Oklahoma City. Other nations have similar processes for their pilots.

Flight Physical Medical Standards

Medical standards differ depending on the Class of Airman Medical Certificate needed. In brief, AMEs verify that pilots meet benchmarks are met for vision, hearing, mental status, neurologic, cardiovascular and general medical status. A detailed review of pilot medical standards is beyond the scope of this article.


In rare situations, if pilots have disqualifying conditions, they can still pursue a waiver. Some aviators acquire Airman Medical Certificates through a temporary waiver process called special issuance. For certain static defects, aviators can pursue permanent waivers known as a statement of Demonstrated Ability (SODA).

How Often Do Pilots need Flight Physicals?

Flight physicals are recurrent requirements. Duration of Aviation Medical Certificates depends on the type of flight operation, age, crew position (captain vs co-pilot) and the number of crew on the flight deck. Healthy airline pilots generally need Class 1 flight physicals annually when young (< 40) and every 6 months thereafter. When problems are suspected, additional testing may be required. If disqualifying conditions are found, temporary or permanent waivers are needed to continue flying.

Next WayPoint - How Are Pilots Screened for Developing Mental Health Problems?

This segment discussed overall pilot medical screening and the series continues with the next segment, Part 3 a more focused review of existing processes for monitoring of pilot mental health. Continue to Part 3: Ongoing Mental Competency Surveillance →

Continue to Part 3: Ongoing Mental Health Surveillance →

Author: John Ogle, MD, MPH, FACEP is one of our senior flight surgeons. An Emergency Physician and commercial pilot himself, the author holds degrees in aerospace engineering, medicine and epidemiology. He is an experienced Air Force crash investigator and former AME.

Editor's Note: This series contains Dr Ogle's personal and professional opinions. His preliminary ideas may or may not reflect those of the FAA, the US Air Force or Details of the horrific crash are still emerging at the time of publication.

— Editorial Staff

Reminder: use to familiarize yourself with aviation medical regulations and guidelines, but always discuss your specific situation with one or more AMEs before dedicating resources toward expensive clinical workups. Find an AME now