Canadian Investigators Call For Improved Medical Screening For Pilots (Updated)


Canada’s Transportation Safety Board is recommending a process be established to update pilot medical requirements following a 2021 crash that may have been related to the pilot suffering a heart attack. The board has issued a recommendation to Transport Canada to ensure the handbook for Civil Aviation Medical Examiners (CAME) “contains the most effective screening tools for assessing medical conditions such as cardiovascular health issues.”

“The intent of the recommendation is for TC to come up with a means to ensure that Civil Aviation Medical Examiners have the most up-to-date guidance available,” said TSB spokesman Chris Krepski. He said improvements to cardiovascular screening were given as an example of how the system could be improved. The TSB says Transport Canada medical examiners are not required to conduct blood lipid screening tests that might have found risk factors in the pilot of the 2021 crash. It referenced a report published in 2019 that the consensus of aviation cardiologists from all over the world is that pilots older than 40 be screened for cardiological risk factors. About half of Canadian commercial pilots are older than 40.

The ATP-rated pilot died after the homebuilt Cavalier he was flying stalled and spun while on a sightseeing flight in Alberta. His passenger was seriously injured. An autopsy determined the cause of death to be blunt force trauma but “with cardiovascular disease as a significant contributing factor,” the TSB report said. Due to COVID restrictions, the pilot’s most recent medical had been done virtually and involved an attestation that he was fit to fly. The board said it’s the eighth crash in the last 20 years in which undetected or unreported heart issues were raised in an investigation.

Russ Niles
Russ Niles is Editor-in-Chief of AVweb. He has been a pilot for 30 years and joined AVweb 22 years ago. He and his wife Marni live in southern British Columbia where they also operate a small winery.

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  1. Sounds like the AeroMed folks in OKC are now running C eh N eh D eh aviation now, too. Eight crashes in 20 years and they want very expensive med testing to do what .. ground them all? So do these same people drive cars and RV’s?

    • Give it a rest Dale, it would appear you cast all through your political filter. Canadian are you? Give it rest, eh?

    • More lives would be saved if you did extensive medical and neuro exams on drivers. But a lot more votes come from drivers then from pilots.

  2. Eight crashes in 20 years that *might* have had cardiovascular issues as a contributing factor. Cardiovascular issues that *might* have been detected by expensive screening.

  3. Holy crap! I feel sorry for our Brothers and Sisters up North. I presume the cost of those tests is on them as well? Hopefully the FAA has their ears turned off…

  4. Except that, in Canada, blood tests requested by a doctor are covered by the provincial health insurance system. There are only a few tests that have to be paid for out of pocket, and they can be reimbursed by most, if not all, private health insurance policies – which most, if not all, Canadian pilots enjoy as a job benefit.

    There is therefore no cost to someone who goes to a lab with a requisition signed by a doctor for a draw for blood lipids tests.

    It’s one of the benefits of a universal healthcare system – so perhaps the American correspondents here could base their comments on the excellent Canadian system rather than the politically-charged, partisan attitude to healthcare prevalent in the US.

      • My wife and I are paying about $1000 a month for medical insurance. I’d be pretty happy with even a $10,000 annual tax increase if it meant having medical care available as a public service – but since countries with national systems generally have lower per capita medical costs than we do, that’s unlikely. Public medical services are some of the most popular things our peer countries provide, and practically nobody envies our “you bet your house” medical system, with bankruptcy looming if you get seriously ill.

        • But then again you countries with Nationalized medicine never mention the “warts”. Long lines, long waits, planning surgeries long in advance, Sheep in Sheep out, it is not all roses as some would have you believe. Also if you are paying $1000 per month ($12000 per year) yes we would all like a cost reduction to $10000 per year, but it never seems to work out that way. When politicians are involved (by the way they know nothing of how insurance or even business really works) they will screw it royally just to get votes, so it will end up in the latrine, like everything else they touch.

    • You paid, just at a different time.

      No one here insulted your excellent country and it’s health care system, don’t disparage ours.

      • I’ve used health care as a resident of both Canada and the US (not at the same time, of course). I once calculated that if I added US health insurance to my US income taxes (paying in full, with no employer contribution), the total would be equal (or a bit more) than what I paid in Canadian taxes.

        Otherwise, my experience is that if you’re in the US and on a good health insurance plan, and in a major metropolitan area, then health care is quick, easy and first-class. In Canada, I’m still waiting – as millions of others are – on a wait list for a family doctor, which is a prerequisite for getting specialist care. The option is to find a community clinic, pay membership fees out of pocket, and hope for the best. To put it another way, if you’ve been in the Canadian system all your life, with a family doctor readily available on speed dial, you’re set. If not, and you’re on the waiting list, good luck.

    • So why do so many Canadians flock to the US for necessary and timely health care rather than dying or suffering degraded quality of life while waiting in line for Canadian health care?

  5. Indiscriminately testing people who have no signs or symptoms of disease is guaranteed to generate many falsely positive test results (quite possibly more than true positive test results, especially if “positive” is is a person who will crash a plane due to a heart condition).

    It is well-established among clinicians and epidemiologists that such testing is poor clinical practice – it leads to additional testing (in follow-up of the false positive) that is potentially risky with no chance of benefit.

    • Correct.

      The workup for a false positive test can be more dangerous than the presumed condition.

      Also, statistically a screening test in a low risk population will always yield more false positive results. This is why we don’t do STD screening on nuns for instance. Any positive test would most likely be a false positive. No value in the testing.

      • … and how many pilots will get a heart attack either worrying about passing such a draconian requirement OR die when they find out they can’t fly anymore?

        And we have friends from up north that come to the US for care vs waiting in line..

  6. Only an angiogram will tell you what is actually happening. A nuclear stress test will hint at it. A blood screening only tells you that you have high cholesterol. That in itself doesn’t indicate you are absolutely at risk. Lots of folks have high cholesterol naturally. I was a runner, normal cholesterol levels, felt fine, had a current class 2. I did feel a slight discomfort for a while when running. It would go away. I finally mentioned it to my family doctor.l He said just go to a cardiologist and get a stress test. I went. Hadn’t felt the discomfort for several months. But he said it could have been angina and only an angiogram would tell for sure. Did one through my wrist. After it was completed he said, “you need at least a triple bypass. You are 90% blocked and due to fall over dead at any time.” The angiogram is the only way to actually know if you are eligible for a sudden heart attack. The blood work only tells you that you might want to eat a healthier diet.

    • Many heart attacks occur in people with clean coronary arteries, and many people with ugly angiograms never have an event. You can estimate probabilities but not predict events.

  7. You didn’t mention your age, but a middle-age or older man with elevated cholesterol who has chest pain while engaging in aerobic exercise that goes away at rest has angina (most, but not all, angina is cardiac in origin) and is “eligible” for a heart attack. The angiogram is the definitive evaluation that demonstrates blockages of coronary arteries and whether bypass or angioplasty is likely to be an effective treatment.

    • Age 72 and cholesterol about 190 at the time. Exercised each day. Mentioned this before, but my hanger neighbor, retired FedEx Capt, current class 2, frequently flew his Aztec, fell over dead, heart attack, while waiting for an oil change at the dealership. I had just given him a BFR a month before. Made me think about the shock I would have experienced if he had done it on short final. React???? Guess, but don’t know.

  8. In the first paragraph of AvWeb’s reporting, the figure of 33,000 pilots refers not to all Canadian pilots, but rather – as made clear in the CTSB report – those who hold Category 1 medical certificates (required to exercise commercial pilot and ATP privileges, and similar to the FAA Class 1 and 2 medicals).

    Also, the CTSB report concludes with a single recommendation: that Transport Canada “establish a framework for routine review and improvement to the Handbook for Civil Aviation Medical Examiners to ensure it contains the most effective screening tools for assessing medical conditions such as cardiovascular health issues”.

    I appreciate AvWeb including links to source material in its reporting.

  9. As you all likely know I am a physician specializing in internal medicine and I’ve been an AME and an active pilot for decades.

    This is BS on so many levels I’d have to take the day off to type it all out (I’m a slow typist) or put you all in a lecture hall and stand on a soapbox for an hour talking about it.

    NO WAY an EKG could detect a cardiac event in any but the rarest of circumstances.
    NO WAY a physical exam could do this either.
    NO WAY lab tests or a lipid panel could do the same.
    NO WAY to link a ‘cardiac event’ to this stall/spin event.
    NO WAY to assume invasion of privacy increases aviation safety.
    NO was to say if this should be done for flying it shouldn’t also be done for driving.
    NO WAY to assume millions of drivers cause less risk to the public than thousands of pilots.

  10. I need to rephrase…

    NO WAY an EKG can predict an incipient cardiac event in all but the rarest of circumstances. It will demonstrate an infarction ex post facto.

  11. I’m wondering how the Canadian cat 1 medical compares to the FAA first class medical. Does it cover more items or is it stricter like some of the Asian and European agencies have been reported? I do know ICAO does not recognize the time limits the US medicals have (calendar months vs 6 months from exam).

  12. As a Canadian ATPL holder over 60, I have to have a medical exam by a MD who is Transport Canada approved Aviation Medical Examiner every 6 months and a EKG, paid for by me every year.

    Since my resting heart rate is 48 bpm and my blood pressure is normal I was advised many years ago to have a double espresso before my EKG so it didn’t trigger a brachardia (sp?) alert and a second level review 🙄

    What we have now is a WW 2 Air Force pilot medical protocol that has been incrementally tweaked. It would seem to me that it is time to reevaluate the entire pilot medical evaluation system. There is in my opinion, zero value in any medical certification for recreational flying. If you are fit to drive you are fit to fly.

    The medical requirements for Professional pilots need an evidence based top down review starting with a blank piece of paper. The current system is just a self licking ice cream cone.

  13. Lets have Transport Canada Safety Board employees and officials (Same with the FAA Medical Board) subject to the same medical requirements as pilots to keep their positions. If they fail the exam they are out of a position. Then we will see how they react. Will they still want the same requirements knowing that one event can end their carrier? They talk safety when it comes to everyone else but will not implement the same playing field for themselves, typical bureaucrats.

  14. Canadian TSB flight operations personnel are required to keep the same level of qualifications as regular Transport Canada Inspectors, that is a valid ATP license (airplane) or Commercial license with instrument rating (helicopter).

  15. It’s not clear form this if the crash caused the heart attack or the heart attack caused the crash.

  16. I’m an ER doc. My job consists of screening people to figure out who is having (or is at risk of having) a heart attack. My false positive rate (people w/ symptoms, but not the condition) is well over 98 %, and those are people who have chest pain. Screening asymptomatic populations is mathematically a fool’s errand and will produce vast numbers of false positives. What is Canada going to do with that information? Ground their entire pilot fleet?

  17. In the 1990’s the FAA tried to establish a cholesterol level test requirement for all pilots. After all the general aviation groups loudly complained the FAA proposal went nowhere and was dropped. Hopefully there are still some FAA medical people around who remembered that and the FAA won’t try that nonsense again. Just think about the stink that was raised about the last time the FAA tried to make certain testing required for sleep apnea.

  18. Lipid testing?

    This is an example of the aeromedical crew showing how far out of touch they are with modern medicine. The false positive rate will be off the charts.

    Then again, that may be the idea. As someone above commented, self-licking ice cream cone.