Why did the FAA change ECG requirements, and what is the change about?

Factual Questions
1

In recent days, there are a lot of websites claiming that:

  • The US Federal Aviation Administration has relaxed ECG requirements for pilots, i.e. people with less-than-stellar ECG measurements will now be medically cleared to fly;

  • This was done because COVID vaccines have caused widespread heart damage in the general public; and

  • This was done without any publicity because the heart damage was caused by COVID vaccines and not by COVID itself, and the government doesn’t want to admit the vaccines are a problem.

Here’s one of the websites discussing the FAA’s recent changes to EKG requirements:

Sites currently discussing this point to the FAA’s change log (PDF) for their Guide for Aviation Medical Examiners - specifically page 4, revisions 6 and 7, which read as follows:

  • #6: In Item 36. Heart, Arrhythmias, revised 1st Degree AV Block into two categories: PR interval
    of less than 300 ms and PR interval of 300 ms or more.

  • #7: In Item 58. ECG Normal Variants List, revise 1st Degree AV Block criteria to “less than 300 ms (0.30 sec)."

The lack of FAA fanfare over these changes isn’t surprising. As the 90-page change log shows, it looks like the FAA makes roughly half a dozen changes to this document every month, and the general public rarely or never hears about any of them.

And a more charitable explanation for relaxing the requirements is that there’s a terrible shortage of commercial pilots. This is a well-documented problem that has been building for many years and was made worse by retirements during the pandemic as well as the the crazy pandemic-related fluctuations in travel demand:

My questions:

  • Can someone with a medical background explain the significance of the ECG parameters referenced in these requirements, and the significance of the changes the FAA has made to these requirements?

  • Is the average person more likely, in recent years, to exhibit ECG results that would have failed the FAA’s previous version of these requirements?

  • If the above answer is yes, are there any known risk factors that could account for these changes - e.g. the increased prevalence of obesity?

2

Not a “medical person”, just a layperson with enough knowledge to be dangerous, but I am, in fact a pilot so I’ll take a stab/bump this until an actual medical person comes along.

First, a bit of history. A lot of physical requirements for pilots were laid down in the WWII era and often were based on military standards, for an environment that is significantly different than civilian/peacetime flying. During the intervening decades it has been discovered/realized that some of those requirements were more strict than actually needed. For example, a vision defect that, when I took my first pilot’s medical in the 1990’s, required additional testing and a document called Statement of Demonstrated Ability to allow full use of a private pilot’s license now no longer requires that “SODA” because really, it’s a non-issue. That’s just the one I have personal experience with. Combine that with better diagnostic testing where we find “problems” or “anomalies” that were undetectable in 1950 (or whenever), that aren’t so much problems as normal human variation, and the result is that a lot of pilots, even commercial ones, were having to undergo additional testing and special documents and so on to the point that someone realized that “hey, this thing here isn’t a problem”. Pilot shortages can give impetus to removing/reducing requirements that don’t affect safety, but this has been an on-going process since at least the 1990’s (when I first got involved in aviation and needed medical certification) and probably even before that.

So… yes, pilot shortages could be a factor here, but it wouldn’t surprise me if these are changes that have been in the works or studied for years already. I don’t know for sure, just saying its a possibility.

I’m not saying there are no obese pilots, but even private pilots have medical requirements, commercial pilots even more so. The average pilot is, as a general rule, less likely to be obese than the average citizen. High blood pressure, diabetes, and a number of other regretfully common problems can ground a pilot even if they would not impair the average person so pilots have some incentive to keep their weight and other health problems under control. Having “keep this under control or you lose your flying privileges” can function as a very strong incentive for pilots.

(I’ll note that over the past few decades diabetics, which used to be barred from flying, have now been allowed to do so under some stringent conditions, a reflection of what I said in my second paragraph. The FAA examiner who gave me my checkride for my license was a diabetic but allowed to fly as a commercial pilot so long as he adhered to some strict requirements. Why? Because Type II diabetics able to maintain strict control and meet certain requirements were not found to be a hazard so the rules were changed to allow them to fly.)

3

I looked into this a bit after seeing Steve Kirsch’s fulminations on the subject (noting that I am not an internist or cardiologist).

It seems that arrhythmias, transient or otherwise are not uncommon in otherwise healthy pilots including young ones as this article relates.

First degree heart block is not considered a serious must-treat disorder, and it appears the findings in the above paper (2018) are compatible with the FAA revised recommendations contained in #7 in the OP.

Heart block - Illnesses & conditions | NHS inform.

So my take at this point is 1) the FAA rule revisions likely were in the works before the pandemic, 2) the criteria changes were carefully considered and do not impact flying safety, and 3) there’s zip evidence that Covid vaccines are causing an increase in cardiac conduction abnormalities among flight crews or other groups.

Steve Kirsch is a multi-multi-millionaire tech bro whose preoccupation these days is fearmongering about Covid vaccines. He’s a leading proponent of “died suddenly” bullshit and other reprehensible slime.

4

Additional background: phony concerns about flight safety due to Covid-19 vaccination are nothing new. The usual cast of antivax loons earlier demanded the grounding of all pilots who’d been vaccinated - again, with a complete lack of solid evidence.

5

By coincidence, an old USAF friend of my now-deceased first wife runs that department at FAA. I have not talked to her directly about this decision.

In prior conversation on the general idea of FAA’s slowly but surely evolving medical standards, she said their Prime Directive amounts to:

Our primary legit concern is sudden incapacitation, with general constitutional weakness secondary. Medical science moves forward continuously. As does statistics gathering. Lots of existing restrictions date from long ago and are blunt tools that exclude lots of pilots for now-unnecessary reasons. Let’s find and fix those as the evidence dictates.

The larger point is that their goal is not to artificially reduce the ranks of the pilots or would-be pilots. But to let everybody who’s provably healthy enough fly. Which definition will change as we have improved abilities for both “provably” and for “enough”. And as we get better treatment(s) for chronic conditions that can now make someone with whatever condition healthy “enough” whereas before there were no such treatment(s).

It’s still the case the standards for the various classes of medical exam differ. “Enough” for airline pilots and “enough” for Cessna pilots are different because the consequences of a medical malfunction in that pilot are different. Which is also why ultra-light pilots don’t need medicals at all. Them falling out of the sky unconscious are deemed to be pretty much a non-event for everyone but themselves.

6

One of my flight students years ago was a cardiologist, and qualified to give medical exams by the FAA. I asked him what the chances were of the EKG finding a problem. His reply: “You would have to be having a heart attack while they were giving you the test.”

But… that’s OK in my mind. I infer from his answer that the EKG is not meant to be diagnostic in that setting. It’s just meant to show a baseline of normal heart action.

I take no position on the accuracy of his statement. Just FWIW.

7

When I was in my early 20s I knew a guy in his early 60s who flew a Cessna. He was extremely absent minded and was colorblind (green/yellow IIRC). I flew several times with him and it was always a bit nerve rattling.

One fall day we flew Pittsburgh to Hershey. Shortly after takeoff he sniffed the air several times, then asked if I smelled something burning. YES!!! I noticed it and was just about to ask. “That’s just the heater”.

Another time we were flying Pittsburgh to Philadelphia and he asked me if I thought that was the turnpike below us.

8

I wonder how many antivax alarmists are refusing to fly for fear pilots will drop dead at the controls.

From a standpoint of lessening contagion risks for other passengers, it’d be a welcome development.

Likewise, do stay out of restaurants and other venues so that I and other vaccinated people don’t shed nasty spike proteins all over you. :grimacing:

9

Or how many vaccinated pilots have dropped dead due to the vaccine. :face_with_raised_eyebrow:

10

Here’s a case from 2017. Probably caused by fear that one day there’d be a pandemic and mandatory vaccination.

Antivaxers have falsely claimed that pilots only started training for in-flight emergencies due to incapacitated pilots after the Covid vaccines were introduced.

11

I flew with a pilot some time in 2022 who told me that when the original vaccine mandate came out he was fully willing to resign and abandon his career as an airline pilot before he would accept that poison in his system. It was evident that he was not blustering; he meant it. I replied that I’d been poisoned 4 times now with no apparent ill effects, twice before the mandatory idea ever reared its head.

The next hour or so in flight was … quiet. All business. Which is fine with me; we’re not all instant pals once locked into our shared broom closet for a few days. I’d rather have somebody with silly ideas be quiet than keep spouting. I imagine he felt the same way. I did not ask.

12

Ugh, pilots who start talking politics. I hear you. But I’ll respond in the General Aviation thread so as not to hijack this one.

13

Heart block is a conduction defect causing a slower movement of the of electrical impulse through the heart. There are 4 main types:
1st degree, 2nd deg type 1 and type 2, and 3rd degree.

More than you probably want to know about heart block.
Heart block - Wikipedia

How those of us who don’t specialize in cardiology remember them:
Heart blocks poem - Bing images
(Mobitz 1 and Wenckebach=type 1, Mobitz 2=type 2)

2nd and 3rd degree blocks can include a slowed heart rate, low blood pressure and subsequent dizziness, and fainting.

1st degree was included on the no-fly list, possibly out of an abundance of caution, and enough research has accumulated to justify removing it. I’m guessing the bolded info is why the FAA made the distinction between more and less than 300 milliseconds of delay. (bold/italic mine)

Isolated first-degree heart block has no direct clinical consequences. There are no symptoms or signs associated with it. It was originally thought of as having a benign prognosis. In the Framingham Heart Study, however, the presence of a prolonged PR interval or first degree AV block doubled the risk of developing atrial fibrillation, tripled the risk of requiring an artificial pacemaker, and was associated with a small increase in mortality. This risk was proportional to the degree of PR prolongation
First-degree atrioventricular block - Wikipedia

I don’t know about the FAA, but the American Heart Association gathers data and updates its CPR and advanced life support protocols every 5 years.

I have no desire to dig into the vaccine claims, but expect that it’s a spurious relationship, wittingly or unwittingly.

14

It would be either red/green or blue/yellow colorblindness. Most likely red/green because it’s more common, but the latter does occur.

I happen to also have a form of colorblindness (deuteranomaly trichromacy which means I’m color “weak” rather than unable to see certain colors, for more details see the thread any color blind pilots out there?)

It’s not that particular issue that makes pilots absent-minded, just sayin’ :wink:

15

I am a MD.
FWIW, Steve Kirsch’s FAA-EKG claim looks to be bogus.

Changing EKG clearance criterion to an “unlimited” PR interval made no sense at all. So I checked the FAA criterion. What I found was the clearance criterion appear to have been tightened, not loosened.

A PRI of 120-200msec is normal. PRI >200msec is considered 1° AV Block. But the chance for dysrhythmia (which is the FAA’s concern) escalates significantly at a PRI >300msec.

Previously, clearance of any 1°AVB was at the physician’s discretion. A pilot with a marked (>300msec) 1°AVB could be cleared without FAA notification if the MD saw no evidence of an associated issue. The FAA changed that. Now all cases of marked 1°AVB require deferral, and FAA notification.

That was what changed.

(Oct 2022 Guide for Aviation Medical Examiners)
(Jun 2017 Guide for Aviation Medical Examiners)

16

Ahh, this portion of my post was based on the assumtion that the requirements had, in fact, been loosened, if not then I retract this bit.

17

I was just going to say that loosening requirements because of an elevated risk of heart damage from shots makes no sense at all, but as shown, they actually tightened requirements.

It may well be due to the increase in adverse heart events. The mRNA shot CAN cause myocarditis and other issues that could affect the heart, but Covid itself is more than twice as likely to do the same, from what I can tell. Combine the two together, and the FAA would rightly look hard at their medical requirements and see if they need to be tightened a bit.

18

Yeah, my understanding is that’s there’s a large increase in heart disease among middle aged people due to lingering effects of covid.

19

Kirsch claims on his site:

On October 24, 2022, the FAA quietly, without any announcement at all, widened the EKG requirements necessary for pilots to be able to fly.

The PR (a measure of heart function) used to be in the range of .12 to .2.

It is now: .12 to .3 and potentially even higher.

The FAA’s guidelines now list 300 ms as the cutoff for deferral. But did those guidelines ever mention
anything about 0.2 before the October revision? Or is Kirsch claiming that PR among the general public used to be 0.12-2, and is now 0.12-0.3? I’m starting to think he meant the latter.

Also, AP news has taken notice of this issue:

And they are in fact calling the changes a loosening of the requirements:

Previously, pilots with first-degree AV block were required to submit documentation proving that they had “no evidence of structural function or coronary heart disease” before they could be certified to fly. The FAA’s recent update to its guidelines specifies that pilots with first-degree AV block and a PR interval of less than 300 milliseconds can be certified without additional documentation if they are not exhibiting symptoms and if their medical examiner does not have any concerns.

The “loosening” they refer to is the fact that examinees with PR interval < 300 ms can be certified without additional documentation, provided the examiner has no concerns. But I’m not seeing that “additional documentation” was previously required. From your June 2017 link, in the section for 1st degree AV block, it says:

Class: All

Evaluation Data: Document history and findings, CVE protocol, and submit any tests deemed appropriate

Disposition: If no evidence of structural, functional or coronary heart disease - issue. Otherwise - Requires FAA Decision

From your October 2022 link, in the section for 1st degree AV block with PR interval of less than 300 ms, it says:

Class: All
Evaluation Data: If no symptoms or AME concerns

Issue Annotate Item 60

So the only relaxation between June 2017 and last October is that “evidence of structural, functional, or coronary heart disease” is no longer an issue for this line item - although it still is for other requirements in the list, which invoke the same “Requires FAA Decision” as this line item did in 2017. And at the same time, they’ve now explicitly said anyone with a PR over 300 ms is deferred, which is indeed a tightening of requirements.

so it does indeed appear that the medical requirements for becoming a pilot are tighter than they were in the before-times.

20

Actually, a prolonged PR-interval CAN be and is associated with increased risks, including sudden death (due to a fatal dysrhythmia). Here’s an article a layperson can understand, from a high-level U.S. institution. And yes, I am a real physician…an internist specializing in cardiorenal disease.