Head Injury

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Definition

This guidance should be used for applicants with mild, moderate or severe head injury

This guidance does not apply to minimal head injury which is defined as:

Any concussive or mild head injury symptoms which have recovered within 48hrs
No loss of consciousness (LOC)
No post-traumatic amnesia (PTA)
No neurological deficit
No seizure

Aeromedical Implications

Effect of aviation on condition

Reduced seizure threshold due to:
- Hypoxia
- Fatigue
- Jet Lag

Effect of condition on aviation

Overt incapacitation from
- Post-traumatic epilepsy (PTE)
- Neurological impairment
Subtle incapacitation
- Neuropsychiatric impairment
- Post traumatic mood disorder

Effect of treatment on aviation

Anti-convulsant therapy
- Masking of seizure risk
- Sedation

Approach to medical certification

Based on the condition

Presence or absence of contemporaneous reports
Quality of contemporaneous reports
Assessment of severity of head injury
Assessment of neurological and neuropsychiatric impairment
Assessment of psychiatric impairment

Based on Treatment

Surgery
Medication
Rehabilitation

Demonstrated Stability

Appropriate surveillance period determined on basis of severity of head injury

Risk assessment protocol - Information required

New cases

Mindful of the time and costs to the applicant, it may be expedient to review the contemporaneous records first, and liaise with CASA prior to arranging further opinions.

Ambulance reports
Emergency Department reports
Hospital notes and discharge summaries
Imaging reports
- CT scans
- MRI scans
- X-rays
Blood test reports
A report from the treating doctor (Neurologist or GP depending on severity) will be required
- Clinical progress
- Additional risk factors for seizure
  - Co-morbid conditions
  - Chronic Alcoholism
  - Psychiatric illness
  - Family history of epilepsy
- Any evidence of post-traumatic epilepsy
- Any evidence of impairment
  - Neurological
  - Neuropsychiatric
  - Psychiatric
- Treatment
- Prognosis
  - Risk of PTE (including reference to medical literature)
- Recommended follow up

Please note: Additional reports from Neuropsychologist or Psychiatrist may be required depending on assessment of the above reports

Renewal

A report from the treating doctor (Neurologist or GP depending on severity) will be required
- Clinical progress
- Any evidence of post-traumatic epilepsy
- Any evidence of impairment
  - Neurological
  - Neuropsychiatric
  - Psychiatric
- Treatment
- Prognosis
  - Risk of PTE (including reference to medical literature)
- Follow up

Indicative outcomes

Favourable

Absence of post-traumatic epilepsy during appropriate period of surveillance
Absence of aero-medically significant impairment

Unfavourable

Continuing anti-convulsant treatment
Evidence of a depressed fracture of the skull
Prolonged (or indeterminate) post traumatic amnesia
Brain contusion
Other abnormality on imaging of the brain

Pilot & Controller Information

All head injuries should be reported to your DAME
Pilots and controllers should seek medical care and assessment as soon as possible following a head injury
A good history of the events at the time of the injury is a crucial information source, as is a CT scan of the brain carried out at the time.
The absence of assessments obtained at the time of the head injury may necessitate longer grounding periods being applied
A period of surveillance on the ground may be required depending on the severity of the head injury

Disclaimer

The Clinical Practice Guideline is provided by way of guidance only and subject to the Clinical practice guidelines disclaimer