Major changes in medical standards used to certify civilian pilots have been proposed to the Federal Aviation Administration in a report commissioned by the agency from the American Medical Association.
The report, summarized in this week's issue of the Journal of the American Medical Association, favors tightening health requirements for pilots of all types of planes by specifically excluding those with various heart ailments, past psychiatric disorders and other conditions.
The recommendations, produced after more than two years of review by AMA staff and consultants, would expand a pilot's required health examination to include cholesterol measurements, glaucoma testing, a detailed evaluation of family health history and other information aimed at assessing future and present health.
The agency commissioned the study in 1983 as part of a plan to reexamine medical standards for pilot certification, which have not been completely revamped since the FAA was established in 1959.
FAA spokesman Fred Farrar said the report will probably be published in the Federal Register for comment and will be considered by the agency in rethinking its requirements.
"It's going to be influential," he said, but added that it may be several years before the FAA completes work on the standards.
No statistics are available on the proportion of accidents caused by sudden illness or death of pilots in the air, according to Frances Sherertz, an investigator with the National Transportation Safety Board.
"There are a very limited number of cases where we know the pilot to have had a heart attack or stroke," she said. "I suspect . . . that there are a significantly higher number of accidents that are due to, for example, people who are flying around and get a severe attack of the flu . . . . We would never know."
Sherertz said pilot incapacitation is not among the 10 leading causes of fatal air accidents. However, she acknowledged that several of those causes, such as misjudging speed and distance, failing to level off at proper altitude or failing to maintain directional control, could occur because of sudden incapacitation.
"It would be very difficult in an investigation to catch that if a pilot dies," she said. "If he lives he could say, 'I had this terrible headache, and I couldn't even think.' But if he dies, we'd never catch it."
Although the proposed rules place new emphasis on high blood pressure, high cholesterol levels and other risk factors for heart disease, the most common cause of sudden death, no data indicates how effective they will be in screening pilots who might die suddenly while flying, according to Dr. Alan L. Engelberg, who directed the review.
Engelberg said the AMA study group concurred with the FAA's emphasis on detecting current illness but felt that it also was important to require testing aimed at finding and preventing future disease.
"Risk factors are not necessarily something that will give you an illness within the next two years, but we feel a person with a cholesterol level of 300 at least should be followed up with a treadmill test" to rule out significant heart disease, he said.
He added, "We're talking safety . . . . Maybe some of the specifics of what we're suggesting will raise people's hackles, but I think overall, pilots expect to be examined and probably welcome it."
The proposals, as well as continuing to deny certification to pilots with a history of angina or heart attacks, would also deny it to those with significant heart murmur, a history of abnormal heart rhythm and several other heart diseases.
They would require a blood pressure of less than 150/95, a normal electrocardiogram and, in applicants over age 50, a cholesterol level of less than 300 milligrams per deciliter.
Diabetics on insulin would be denied certification, as now, but those whose blood-sugar level is controlled by pills could in some cases be certified.
The report recommends that epileptics and other applicants with a history of seizures or unexplained fainting be free of seizures for 20 years, without medication, before being certified. It also makes specific recommendations on standards for lung function and red blood-cell count and tightens vision and hearing standards.
Pilots with various serious psychiatric disorders would be excluded. Applicants with a history of drug abuse would have to be drug-free for five years, and recovered alcoholics would have to have abstained for two years. The proposal concurs with FAA rules allowing exceptions for recovered alcoholics being closely monitored.
Suggested for the first time is a five-question test of mental functioning to check short-term memory, calculation and ability to perceive shapes. Applicants who failed to answer the five correctly would be subjected to a more detailed examination.