[Doczilla]

From a USAF FS friend....

'zilla

BLUF: 2 weeks following X-ray confirmation of resolution.


First, the pneumothorax should be complete resolved otherwise no flying unless they have a one-way hemlich valve for rotatary or fixed wing aeromedical evacuation. Will this be a passenger or an aviator (since crew members would require a waiver for flying status at least in the USAF don't know about the USA). Also was this a spontaneous event or was there a traumatic cause?

For return to flight status for a patient/passenger then the following should be met:
1) X-ray evidence of complete resolution of the pneumothorax (recall Boyle's law: in flight lower pressure means air will expand thus any unresolved air will enlarge and could cause an acute problem or tension).

2) Most commerical airlines will require 2,4, or 6 weeks after resolution prior to flying depending on if it was spontaneous or traumatic in nature. One case study showed no problem with 14 patients who flew after 14 days whereas 1 of 2 who flew under 14 days had chest pain. These are completely arbitary and not based on scientific evidence. Survey of cardiothoracic surgeons after thoracotomy or mediastinoscopy recommended 7 to 60 days not to fly. Very limited literature on this matter.

3) Also consideration for supplement O2 during flight.



Requirements for aircrew:
Spontaneous pneumothorax is presently disqualifying for an FAA medical certificate of any class unless the situation has been resolved radiographically and there is no underlying lung disease involved. Although the FAA has denied certificates on the basis of SP recurrence without treatment, this stance by the FAA is considered insufficient due to the very high likelihood of a future SP and the subsequent hazard to the airman and the general public.

Both the US Army and the US Navy classify spontaneous pneumothorax as disqualifying for flight duty. Airman are removed from the flight program or denied entry if an attack has occurred within the three year period preceding the medical exam unless it has been surgically corrected with a good prognosis. The United States Air Force is stricter; any history of SP is disqualifying for entry into the flight program. Retention in the USAF program is possible following a single isolated SP episode with full recovery or following successful surgical intervention with six months of grounded observation including hypobaric altitude chamber tests.

NASA currently has the strictest medical guidelines with regard to SP. Entry into the aerospace program is possible if the SP has been surgically corrected and no recurrence has been demonstrated within five years. For retention in the program, the condition must be corrected surgically with six months of observation and no incidence of recurrence.

Confusing enough?