FAA ECG Policy Fits Pattern of Positive Reform

In late October the FAA changed its standard on electrocardiogram (ECG) findings for medical applicants, decreasing the types of results that would lead to a medical deferral. While Class II and III medical holders are not subject to routine ECG testing, the FAA also mirrored the change in its protocol for heart arrhythmias, which all airmen are required to note if diagnosed.

The change allows airmen with a “First-degree AV (atrioventricular) block with PR interval less than 300 ms (0.30 sec)” to receive a medical certificate without deferral. This change was actually known informally to the aeromedical community as far back as 2018 but was formalized in the October change to the FAA’s list of 18 “normal abnormal” ECG findings that do not require medical deferral.

The FAA made this change because airmen with this abnormal – but benign – result almost never showed any concerning indications upon follow-up testing, so the FAA eliminated the deferral requirement.

This fits a pattern of recent reforms at the FAA’s Office of Aerospace Medicine, currently under the leadership of Federal Air Surgeon Dr. Susan Northrup, that is gradually making the application process easier for airmen. While EAA continues to work aggressively to reduce barriers to medical certification, Dr. Northrup – a GA and warbird pilot herself – and her team have been very receptive to change and community input.

Unfortunately, there have been recent allegations that the ECG change was due to an ulterior, political motive. This is absolutely false, and the associated personal attacks on Dr. Northrup, a career public servant and U.S. Air Force veteran, are inexcusable. Given the criticism, often warranted, that aeromedical certification is too difficult in the United States, it is ironic that a change that removed a medically unnecessary barrier to easy certification has garnered controversy.

Dr. Stephen Leonard, EAA Aeromedical Advisory Council chairman, explained, “rather than requiring AMEs to defer the exams of pilots showing those changes, and requiring the pilot to schedule consultation with a cardiologist and a few thousand dollars’ worth of testing, FAA authorizes us as physician examiners to question the pilot, verify that there are no associated symptoms or other conditions that might indicate a clinically significant cardiac issue, and go ahead and issue the medical certificate.”

Dr. Leonard further clarified that “we still send the EKG to FAA, their doctors still review it, and if they have any question, they follow up. Never, in 42 years as an AME, have I seen one of those ‘normal abnormals’ turn out to be clinically or aeromedically significant.”

Other recent FAA reforms include a new policy on situational depression and mild post traumatic stress disorder (PTSD), two very positive steps as the FAA looks to overhaul its mental health policies. There is much more work to be done, but EAA looks forward to accomplishing it together with Dr. Northrup and the Office of Aerospace Medicine in the coming years.