Head injuries
Medical issuance after a knock to the noggin
Recent changes in aeromedical policy affect how the FAA reviews certain types of closed head injuries. More specific definitions are now in place to distinguish between a “head injury” versus a “brain injury.”
These two potentially aeromedically significant conditions have heretofore been a basis for a deferral of medical certification for FAA review. Now, with the changes to the guidance in the Guide for Aviation Medical Examiners, concussions, closed head injuries, open head injury, and traumatic brain injury are better differentiated as to “issue in the office” or “defer for further review.”
For a head injury that has no brain injury, no concussion, no neurological symptoms, and the physician can identify that the condition was indeed a head injury with no brain involvement, the medical certificate may be issued in the office. A superficial scalp laceration from walking into the trailing edge of the flaps on the Skylane with no serious facial, eyeball, or eye injuries that persist—and the injury doesn’t suggest even a mild concussion or concussion symptoms such as headache, dizziness, nausea, or other neurological symptoms—would be a common scenario for pilots in which the AME may issue a medical at time of examination.
Brain injuries that occurred more than five years ago involving a concussion or other mild brain injury with no history of seizure are also at the AME’s discretion for issuance after reviewing all pertinent medical records of the injury. Have all your medical records with you at the time of examination to avoid a deferral.
For brain injuries within the past five years, a six-month recovery period is needed, and all records should be made available to the AME. Concussion, all other brain injuries with loss of consciousness, alteration of consciousness, and post-traumatic amnesia, and classified as mild, moderate, or severe, requires deferral to the FAA for review and probably will result in an extensive neurological evaluation with imaging studies and neurocognitive testing for reissuance consideration. Recovery time for mild, moderate, and severe brain injuries have observed time limits of six months, 12 months, and five years respectively before the FAA can review medical records for possible issuance.
Gary Crump is director of medical certification in the AOPA Pilot Information Center.
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