Head Injury

Guidance for medical examiners when assessing a patient for either a general topic or condition – Head Injury.

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 and 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

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Disclaimer

The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.

Last updated:
Online version available at: https://www.casa.gov.au//licences-and-certificates/medical-professionals/dames-clinical-practice-guidelines/head-injury
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