Developed in collaboration with CASA Medical.
Head injury, also known as traumatic brain injury (TBI), is an injury to the brain caused by an external mechanical force. TBI may lead to temporary or permanent impairment of cognitive, physical and psychosocial functions. Aeromedical decision making and the return to flying or operating for pilots and controllers takes into account a range of factors, including the severity of head injury.
Head injuries can be classified into 5 broad categories – minimal, mild, moderate, severe, and very severe based on Glasgow Coma Scale (GCS), loss of consciousness (LOC), post traumatic amnesia (PTA), clinical outcomes, and neuroradiology imaging findings. There are other features that can help to determine the severity of head injury as described in the table below. There is no universally accepted classification for TBI.
Head injury can lead to overt and subtle incapacitation and affect performance. 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 crucial information. The availability of full information about head injuries eg medical assessments and reports (including paramedic and witness reports) obtained at the time of the head injury may facilitate an earlier return to flying or operating.
A period of surveillance on the ground may be required depending on the severity of the head injury because of the risks related to impaired cognition, mood changes, stroke, or seizures.
High likelihood of seizures is not compatible with flying or controller duties.
The 2025 USAF Waiver Head Injury Severity classification has been used for this guideline. Please note that it can be difficult to appropriately categorise head injury and caution must be exercised. Therefore, if any of the symptoms are outside of the limits, or in case of doubt, then the higher grade of severity should be assigned.
Note 1: Symptoms may include mild confusion or feeling dazed but should not include LOC or frank amnesia
Note 2: Non-epileptogenic imaging features:
Note 3: Epileptogenic imaging features:
Note 4: Very severe epileptogenic imaging features include: penetrating injury, volume loss > 25cc, shunt placement. Clinical features of a very severe TBI include ongoing significant clinical deficits and the presence of a late posttraumatic seizure.
The main concerns following a head injury are:
Minimal head injury is not safety relevant or of aeromedical significant and is defined as:
If the above criteria are met after ME review the pilot or controller may return to flying or operating after confirmation of full recovery.
Reduced seizure threshold and worsening/inducing concussive symptoms due to:
Overt incapacitation from:
Subtle incapacitation:
Pilots or controllers must have no residual neurological deficit, no residual cognitive deficit or other functional or mental impairment that is of aeromedical significance. Pilots or controllers must have no elevated risk of PTE.
See table below for the typical restrictions, please contact CASA or CAA NZ for any concerns.
| Head injury severity | |
|---|---|
| Minimal |
May return to flying or operating after ME review. |
| Mild |
Must have full recovery before returning to flying and this has occurred within 45 days of the injury. Minimum grounding period of 1 month. Class 1, 2 and 3 may return to aviation duties unrestricted after clearance by the AME |
| Moderate |
Minimum grounding for 6 months following injury and full recovery. Class 1-multi crew for 1 year (reassess at 1 year). Class 2 and 3 may return to aviation duties unrestricted. |
| Severe |
The usual grounding period after a serious head injury is 10 years or more. Every severe head injury is different as are flying or operational circumstances. Thus, some injuries may be considered on a case-by-case basis 5 years after the injury. Class 1 and 3 The following may be considered on a case by case basis by CASA or CAA:
Class 2 Grounded for 5 years and a conditional return to flying may be considered after this time by CAA. |
| Very severe |
These injuries are permanently disqualifying. |
The assessment of pilots or controllers following head injury requires individualised risk assessment as the features of each case are unique. These features include the degree of clinical recovery from the head injury, the results of investigations and neuroimaging, and the presence of any significant co-morbidities.
Mindful of the time and costs to the applicant, it may be expedient to review the contemporaneous records first and liaise with CASA or CAA NZ prior to arranging further specialist opinions:
A report from a Neurologist will be required:
A report from a Neurologist or GP will be required:
Minimal and mild head injuries are not of safety relevance or aeromedical significance if the following criteria are met.
| ME must review | Tick |
|---|---|
| Pilot or controller has made a good recovery and is asymptomatic within 45 days from date of injury. | 
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The head injury meets ALL criteria for minimal or mild head injury as defined in this guideline. Medical records, reports and any imaging are reviewed by ME to support this. No post head injury neurosurgical procedure. |
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| Normal full neurologic examination. |
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| No diagnosis of PTE, seizure post head injury, or post injury prescription of antiepileptic meds. |
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Neuroimaging (CT or MRI head) show no evidence of any of the following:
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| No significant mental health, cognitive, or AOD co morbidities. |
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| Appropriate stand down from flying or controlling for mild TBI – at least one month from date of injury. |
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| DAME or ME considers safe to certify. |
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All new applications with moderate, severe, or very severe head injuries must be assessed by CAA. An AMC referral to CAA is required if the pilot’s or controller’s condition does not meet all the above criteria and the applicant consents to their condition being considered under flexibility to the CAR 67 rules.
