class 1 fail

[ashdaman]

hi i was thinking of having a class 1 medical

My question is:
if you did happen to fail say for example you was unfit can you reapply??

Thanks:bored::bored:

[HEATHROW DIRECTOR]

You can take it as many times as you like but if they find some permanent problem which would disqualify you it wouldn't be worth it..

[gingernut]

What's your concern ?

[ashdaman]

just general fitness really. i get tired quickly when i run

[gingernut]

Living in St Helens, I expect you have to run quite often. (Only kidding.)

Don't confuse physically fit with medically fit.

They test the latter, not the former, and there is a big difference.

I've never seen a pilot run yet. If I did, I'd probably run to :)

[sycamore]

Ashdaman, being tired when you run is only in the mind...keep thinking of the `objective` and keep saying to yourself.. ` it`ll get better,it`ll get easier` there`s a beer/virgin/McDs after this`,repeat as necessary.....

[Genghis the Engineer]

It's a medical examination, not a fitness test.

G

[cavortingcheetah]

Actually in South Africa, over the age of forty, you have to do a stress ECG each year for a Class I renewal. This means running on a treadmill for a minimum of eight minutes. A lifetime of pure sinful excess means that this ordeal is very much a fitness test. The medical examiner in South Africa is well within his rights to make a notation to the effect that the candidate is physically lacking in endurance. The medical forms pass through the Military Medical Institute (MMI) for final approval. You can be passed as fit with the requirement that you are considerably fitter next time you apply for a renewal. This of course is all good for the blood pressure!

[Qwikstop]

You are not supposed to run on a treadmill test. Stage 4 is more like power walking on a gradient. The evidence for stress testing being useful for detecting coronary artery disease in asymptomatic individuals is not well established.

[cavortingcheetah]

I'm not sure though that a stress ECG is inconsequential. Internet research into medical subjects is always potential trouble but I think there's enough out there on some of the more intelligent websites to indicate that stress ECGs can help early diagnosis of certain problems. It seems to me that especially with regard to the fluctuations of diastolic blood pressures, the dangers of individual hypertension can be better interpreted. I'm no medical man and I hate doing the treadmill when it's 28'C at 5,500ft but I would not want a stroke caused by high blood pressure if a stress ECG could have seen it coming.
It's always a relief after the stress ECG to find that a heart attack didn't happen. It kind of reinforces the conviction that a life spent exercising is a lot of time wasted because death is death and torturing your body doesn't prolong life for one moment.
(Gingernut, who I think knows how to sharpen a scalpel, and is a helpful in these matters, might have some pithy comments to make on mine?)

[talkpedlar]

hi i was thinking of having a class 1 medical

Hmm This implies, Ashdaman, that you are not required or obliged to submit yourself for a Class 1 medical... What is this all about? :confused:

[gingernut]

(Gingernut, who I think knows how to sharpen a scalpel, and is a helpful in these matters, might have some pithy comments to make on mine?) - I try my best to keep my patients away from sharp scalpels:)

I guess, what we're trying to get to the bottom of, is whether or not the use of stress ECG's, in fit healthy individuals, predicts those pilots that are likely to die at the wheel.

I'm no expert, the patients I send for exercise testing (walking on a treadmill whilst wired up to an ecg) are sent because they have symptoms. (Usually chest pain.) It's used to see if they have ischemic heart disease.

I've not heard of any evidence for it's use in healthy individuals in predicting death at the wheel or yolk. Perhaps someone more informed could enlighten us.

The questions I'd ask before advocating it's use for healthy pilots would include:


How often should we perform it-(would Fabrice Muamba have passed the day before.)
How would we deal with "positive" cases
Is there an easily recognised latent or early symptomatic stage that can be recognised by the test?
Is a mortlity rate of 1:10,000 acceptable?
How do we deal with the false positives. (In effect we'd ground 5% of pilots who undertook the test-immediately.)

There are alternative tests, which claim to predict risk of cardiac events, by measuring plaque deposits in the coronary arteries, but quite frankly, they are a waste of time. (Doesn't every Westerner my age have some degree of furred arteries?) - the key is translating these findings, to risk of event, which unfortunately is no better than having your risk factors (bp/smoking/age/choleserol etc) measured and analysed.

Safe flying:)

[cavortingcheetah]

Thank you for the input. The next time I mount the mill in preparation to see whether I am sufficiently unfit so as to have a heart attack while I'm on it, I shall remember to make your points with the AME. My money says that he'll just tweak the incline up a little. There is no doubt that in South Africa and for Class I medicals, rightly or wrongly, the ECG machine is used as a fitness meter.

[afhelipilot]

Instead of bothering yourself with such a detail, why don't you at first apply to the airlines, and after being accepted just take this 1st medical Test. You ought to feel much better and you will not think so much about the running issue of yours, it's a small detail really.. But, if you shall still feel as not fitting in then just resign as I did for a while,but I'm a girl and at that time I thought I know no one out there and thought I really like to be with my mum around.
Certainly, you shall not be asked any questions regarding your running status unless you shall talk about it. Just apply and at latter take a test.

[homonculus]

Gingernut

You are quite right - there is no test on earth that predicts who is going to drop down dead. The CAA is well aware that pilots still die at the controls and there is no way of eliminating this.

Statins certainly reduce sudden death as may aspirin.

However more and more regulators are grabbing at straws and moving towards stress ECGs and even angiograms. The problem is that you get false positive stress ECGs and then end up with an angiogram which has both a mortality and morbidity ie some completely normal pilots will be harmed

The real answer is a calcium score which if low effectively rules out coronary disease. CT and MRI angiography carry no mortality and give the same information and an angiogram.

[Qwikstop]

Statins certainly reduce sudden death.

The current advice is to consider statins if there is a 20% or greater 10-year risk of developing cardiovascular disease (1) (http://www.nice.org.uk/nicemedia/live/11982/40675/40675.pdf). There is some evidence that statins reduce the incidence of sudden death by an effect unrelated to lowering lipids (2) (http://www.medscape.com/viewarticle/723603). However, there is no evidence to suggest this is effective low-risk populations.

The real answer is a calcium score which if low effectively rules out coronary disease.

Even that isn't quite true. Even total coronary occlusion frequently occurs in the absence of any detectable calcification (3) (http://www.ncbi.nlm.nih.gov/pubmed/20170786).

The message is that predicting cardiac events in low-risk groups is very hard.

[gingernut]

Unfortunately I'm a little out of the loop, relying on secondary research only. The last I read, suggested that the risk / benefit tilt point for statins is around 7% (the 20 % figure set by NICE has more to do with health economics rather than clinical benefit)- hence my tongue in cheek remarks about "pouring statins in the water."

As far as I can see, calcium scoring is no more accurate than population scoring, (Framingham/Sheffield Tables etc) ie, it can identify the risk of, say, you dropping dead of a heart attack in the next ten years, what it can't do (and this is the crucial point) is to identify, with any degree of certainty, which pi lots are going to drop at the yolk.

As you state, homo, anything more sensitive / specific could cause more problems than they solve.

Working in primary care, and being a pragmatist, I'd have to try and work backwards. I'd start by asking how many passengers have been killed as a result of unpredicted heart disease in the pilot.

Wouldn't we be better spending the money we use for stress ecg's etc on oily fish? After all, you never saw a Fijian have a heart attack until they discoverd Burger King.

[Tom!]

I still remember my initial class 1 a few years back. The doc was concerned with an irregularity on my ECG and said he would order a few extra tests on my bloodwork to rule out something and follow up with me.

I was scared sh*tless for a few weeks and then out of nothing my Class 1 dropped in the mailbox. Wonder what will happen next year when I need the full renewal incl ECG again...

[ABZ777]

There's nothing to worry about regarding 'fitness' for the UK CAA class 1 initial medical examination at Gatwick unless you declare on the medical questionnaire that you have, or have had a history of asthma. Not wanting to lie I declared a history of mild asthma and was made to undertake an 'exercise spriometry test' giving the CAA the right to charge an additional fee of £35 to run round the building for 6 minutes. I was completley unprepared for this and failed, and I wouldn't consider myself unfit. A few months later after sorting out some other issues I returned to Gatwick to re-do the exercise test (again at £35) which I passed after preperation.

[Halfbaked_Boy]

ABZ777,

How odd - I took my initial Class 1 in 2006, declaring mild asthma and use of a ventalin if required, but they pretty much swept past that without requiring me to undertake any tests or the like...

[ABZ777]

How odd - I took my initial Class 1 in 2006, declaring mild asthma and use of a ventalin if required, but they pretty much swept past that without requiring me to undertake any tests or the like...

My thoughts exactly, I too never heard of anyone being asked to do an exercise spirometric test on the basis of a history of asthma! My FPV1 dropped 14.7% between resting and exercise. A drop <10% is required for class 1 privileges, and with a little exercise preparation and a costly CAA consultancy fee I was able to improve this and actually improved FPV1 after exercise. It is nothing to worry about but caught me out unprepared!