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Old 9th Jan 2018, 10:09   #1 (permalink)


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Class 1 referral - the wait

Morning

I had an initial class 1 in mid-Oct which required a referral due to a previous diagnosis of myopericarditis. The AME said normally a cardio review is required however due to it being very historic and with no lasting effects he sent a covering letter outlining the investigations and results at the time. (Angio/Echo)

I can’t find anything current regards waiting times and obviously don’t want to upset the CAA by chasing it up!

Can anyone advise on current waits? Should I be worried?
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Old 9th Jan 2018, 14:30   #2 (permalink)
 
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I have recently been involved dealing with CAA and AME so I will pass on what I have learned. I would get in touch with the AME who sent the letter and he/she should be able to contact the CAA and find out where your letter is in the system. The CAA should be able to tell you whose desk the letter is sitting on or if it arrived at all ( I always sent any mail to the CAA recorded delivery so you can start a paper trail )

It is impossible to contact the CAA by phone. I suggest you go to their website and use the notified email address. I would ask something along the lines of “just enquiring how my.....is progressing”. Keep the tone light and polite and always include your CAA reference number in any correspondence. I found it took anywhere between 10 to 30 days for a reply.

I would have thought you should have heard by now, altohough it can be a slow process.

It took eight months to sort out the medical problem I was involved in!
Just keep plugging away!
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Old 9th Jan 2018, 15:43   #3 (permalink)
 
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If the myocarditis was a long time ago and you had no problems and have lived a normal life since I am not sure why you are being referred. I am not an AME but know people have got Class 1s with no investigations if they had no heart failure or arrythmias....

My reading of the CAA's current rules is that you are OK to go if the pathology has resolved and you have a normal post pericarditis echo (to 'exclude heart failure'). You will have an ECG anyhow so that is irrelevant

Not sure why you had an angio, and there may be more to it, but might be worth checking the AME, who may not be a consultant cardiologist, isnt running for cover

PM if you wish
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Old 9th Jan 2018, 19:49   #4 (permalink)


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Thank you for your responses. Iíll start to chase up (lightly) with the relevant parties.

Radgirl- having issues with PMs. Will try to resolve and will send some more info.
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Old 9th Jan 2018, 22:42   #5 (permalink)
 
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Quote:
Originally Posted by Radgirl View Post
I am not sure why you are being referred. I am not an AME but know people have got Class 1s with no investigations if they had no heart failure or arrythmias....
You have been referred because it is mandatory for the AME to refer this decision to the CAA - as stated in the Acceptable Means of Compliance (AMC) for abnormalities of the pericardium, myocardium or endocardium quoted below;

Quote:
8.1 Applicants with a primary or secondary abnormality of the pericardium, myocardium or endocardium should be assessed as unfit. A fit assessment may be considered by the licensing authority following complete resolution and satisfactory cardiological evaluation which may include 2D Doppler echocardiography, exercise ECG and/or myocardial perfusion imaging/stress echocardiography and 24-hour ambulatory ECG. Coronary angiography may be indicated. Frequent review and a multi-pilot limitation may be required after fit assessment.
If, as you suggest this episode was some time ago, then forwarding your investigation results from that time along with a covering letter would be a perfectly reasonable initial approach to the AMS. It very much sounds to me like your AME is following the requirements correctly and proportionately, rather than "running for cover".

However after almost 3 months, it would certainly be worth chasing this up with your AME to ascertain where the CAA are with this.
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Old 10th Jan 2018, 11:54   #6 (permalink)
 
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Thank you for this information Tyred. I presume you are an AME or have better knowledge than us mere mortals!!!! The applicants I am aware of took their initial at Gatwick and as far as we know the matter was not even referred to a cardiologist on the day. As a clinician I see no reason to withold a medical for historical pericarditis without an effusion, arrythmia or documented fall in ejection fraction on echo. I accept the AME is covering his backside, er 'referring to the licensing authority' and it appears he has to do so, but many AMEs seem to flip an email or make a call and get a quick response. I know this approach is somewhat frowned upon but I am not an AME so perhaps I can be excused for criticising a system that is slow and causes alarm amongst applicants.

Hopefully OP will be reassured by your post and we hope the 'initial approach' will simply give the green light and not need further investigation or review.....
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Old 10th Jan 2018, 21:17   #7 (permalink)
 
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Wannabedriver, I don't wish to derail your thread further, but I think it is important that people understand what an AME can and can't do in terms of the decision making process. If the CAA's acceptable means of compliance or guidance material say that a decision can be made by the licensing authority, then your AME is not permitted to make the a decision and the certification decision must be made by the CAA - specifically by the doctors in the medical department. They may or may not need to obtain a further opinion from a cardiologist depending on the clinical reports from your treating doctors, but the certification decision in this situation can ultimately only be made by the CAA doctors.

It sounds like your AME has done exactly the right thing by forwarding the existing clinical information with a covering letter rather than sending you off to a cardiologist for new investigations. I agree 3 months is longer than usual and it would be perfectly reasonable to enquire what progress has been made. I hope that helps.


Quote:
Originally Posted by Radgirl View Post
Thank you for this information Tyred. I presume you are an AME or have better knowledge than us mere mortals!!!!
Radgirl, as per my previous response, if the CAA information states that a fitness decision can be made by the licensing authority, then the AME must refer the decision to the CAA doctors and the AME is not permitted to make the decision. The reference material is freely available on the CAA website to anyone who wants to read it, not just AMEs. I think you have been most unhelpful to the OP by twice suggesting their AME has only referred the decision because he is "covering his backside" or "running for cover". I hope you can now understand that in these circumstances, only the CAA doctors can make the decision and that is why the AME has correctly passed the matter to the CAA for a decision.

Quote:
Originally Posted by Radgirl View Post
The applicants I am aware of took their initial at Gatwick and as far as we know the matter was not even referred to a cardiologist on the day.
I think the key phrase here is "as far as we know". Happy to comment if you could provide facts rather than speculation.

Quote:
Originally Posted by Radgirl View Post
As a clinician I see no reason to withold a medical for historical pericarditis without an effusion, arrythmia or documented fall in ejection fraction on echo.
So as an AME, how would you confirm that there is no effusion, arrhythmia, adequate EF etc? Because an applicant said so? Or would you too want to see written reports from their treating clinicians - which the OP has confirmed have been provided and forwarded to the CAA in accordance with their written protocol.

Quote:
Originally Posted by Radgirl View Post
I accept the AME is covering his backside, er 'referring to the licensing authority' and it appears he has to do so...
They are not covering their backside, it is a mandatory requirement to refer and I have advised where this is written. Please accept that instead of disparaging the AME once again.

Quote:
Originally Posted by Radgirl View Post
many AMEs seem to flip an email or make a call and get a quick response. I know this approach is somewhat frowned upon but I am not an AME so perhaps I can be excused for criticising a system that is slow and causes alarm amongst applicants.
That may be a reasonable approach for small things in existing med cert holders, but you simply won't get approval over the phone or a quick turnaround for a class 1 initial where clinical reports will have to reviewed by the CAA doctors. I agree the timeframe should be quicker (who doesn't?), but the only thing I see causing alarm here is you suggesting to the OP that their AME is not up to scratch.

The process is without doubt very far from perfect, but the AME is frequently constrained in what they are permitted to do in terms of certification decision making by the CAA and EASA, so perhaps you should direct your frustration in the direction of those organisations rather than the AME? Morale amongst AMEs is probably at an all time low for a number of reasons that I won't go into here (just ask any AME if you really don't know), but as you appear not to understand the process or the differences between clinical and regulatory medicine, then perhaps you should refrain from making inappropriately snide comments on here about the AME "running for cover" and "covering his backside".

Quote:
Originally Posted by Radgirl View Post
Hopefully OP will be reassured by your post and we hope the 'initial approach' will simply give the green light and not need further investigation or review.....
And that is the only part of your posts I can agree with.
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Old 11th Jan 2018, 13:09   #8 (permalink)
 
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Goodness gracious Tyred, do relax

As we agree, the idea is to reassure OPs where possible. You and I both know that if Wannabedriver had rolled up for some major operation we would have gone ahead without any further investigations. He pointed out he has had an echo so we have the data!

As you quote, I noted the AME had to refer to the CAA, but that doesnt prevent us from chiding the system for being slow, bureaucratic and inflexible. I certainly can give you evidence that people have been waved through a Class 1 at Gatwick without referral but patient confidentiality prevents me naming them here.

IMHO the new system whereby a pilot can only contact his or her AME who then has to pas the message is not an improvement. When the issue is relatively straight forward and accompanied with the necessary data, as appears to be the case here, I dont think it unfair to suggest OP could be handled faster and better.

Anyhow, I am glad you agree the system needs improving. And I am not having a go at the AME whoever it was.
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Old 12th Jan 2018, 22:05   #9 (permalink)
 
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All perfectly relaxed here my dear Radgirl, just unwilling to stand idly by whilst you have another unjustified pop at an AME (definitively not me btw!).

As for your latest comments that aviation medicine is comparable to having an operation and how you really really really werenít having a go at the AME - well, they certainly raised a good old chuckle.

I expect youíll be back to ensure you have the last word but as Iíve made the points I wanted to make, you are most welcome to it!
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Old 13th Jan 2018, 19:50   #10 (permalink)


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Thank you for your responses once again. I genuinely believe the AME was acting in my best interest - potentially saving me the cost of a cardiology review which they could have easily said was a certain requirement.
My concern lay only with the time taken to date. (Still nothing). I suppose thereís been Christmas and New Year to account for as well.

Iíll report back with the end result.
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