Civilian Air-crew Medical Standards

Countries expect highest standard of (personal) fitness (and ability) for all type(public) transport operators. For reason here accidents could cause (serious) human (and environmental consequences.)

This aim stays accept (as the basis) for grading the completeness (strictness) of these Medical Standards (and the timing of revalidation examinations for various categories of licenses and age groups).

(Unacceptable) pilot incapacitation (and the resultant risk to flight safety) is of concern (since the earliest days of flight). These happen in all age groups, at all phases of flight, and take many forms.)

Spacific incapacitation training drill is result (of mandatory introduction in 1973) for pilots (all category in airline operations). Risks (to operational safety imposed by all forms of incapacitation) dropped.

(Chapman, 1984 did an extensive evaluation of the impact of training, when incapacitation was introduced into routine simulator flight checks in conjunction with incapacitation training drills. Acute and subtle events were simulated ai critical phases of flight, both as an isolated occurrence and in association with failure of another critical flight system. This study showed that in airline operations, the reported crash rate of 10 to the power of negative 10, resulting from 'crew failure' was at least ten times better than the standards for failure of comparably vital aircraft systems.)

Not all pilots operate in multicrew role (and also that incapacitation drills so exceptionally effective in fixed wing aircraft are currently not demonstrably so in helicopter operations.)

(The Convemtion on International Civil Aviation which was signed in Chicago on Dec 7th, 1944, called for the adoption of International Regulations in all fields where 'uniformity of practice would facilitate and improve air navigation'. The agreed Standards and Recommended Practices (SARPS) are promulgated in annexes )

(The International Civil Aviation Organisation (ICAO) Medical Standards are contained in the ICAO publication Personnel Licensing (Annex 1, Chapter 6 - Medical Requirements). Current standards were published in 1982, and will be referred to in this Chapter as Annex 1 Standards)

(Most countries that are members of the United Nations have adopted and adhere to these Standards, which cannot cover all eventualities but present in basic outline minimum requirements to be maintained for each class of licence. The Medical Examiner is asked to exercise clinical judgement, in the light of his knowledge of the clinical judgement, in the light of his knowledge of the particular privileges granted by the license and the specific flight environment involved, to determine whether the certificate may be issued or deferred. The Manual of Civil Aviation Medicine (1985), published by ICAO, gives extensive guidance to aid this decision and amplifies the standards in considerable detail.)

(In formulating recommendations for the grant and maintenance of a professional pilot's license. ICAO has to take note of General Standards of Medical Examination and facilities common throughout the contracting States. Care is taken that recommendations made are such as can be readily met by developing nations.)

(National Standards set by individual nations amplify in detail those of Annex 1, and may be higher than ihose required by ICAO, leading inevitably to a minor degree of variation between one signatory country and another. There is, however, agreement on the basic ICAO standards. National variations in standards that are less stringent than those of Annex 1 must be notified by the country concerned to ICAO. The United Kingdom, for example, advised in 1985 of variations in the period of validity of medical certification for the younger age group of private pilots.)

(In the United Kingdom, statutory requirements detailing conditions of issue and renewal of all types of aircvrew licences, including medical requirements, are contained in the Air Navigation Order 1985 (Civil Aviation Authority, 1985). The Civil Aviation Authority gives details of details issued by other licensing authorities. National variations also arise in the requirement for, and periodicity of, such special investigations as chest radiography, audiometry and electrocardiography in various classes of licence).

(The airliner, as an employer, may impose medical standards that are more stringent than other ICAO or national standards. The financial cost to the employer of initial and continuation training is such that premature loss of aircrew through avoidable medical causes must be minimized. The airline and the candidate also expect a lifelong career prospect.)

(There is, therefore, a moral duty imposed on the aviation medical examiner - particularly at the initial examination - to advise the candidate meeting only the minimum ICAO standards permitting a licence, that acceptance by a major airline for training and employment may not be assured.)

(If, following medical examination, the two questions posed above are answered satisfactorily, a medical certificate is issued for a licence, valid for the period relevant to the specific class of licence. This certificate cannot be withheld even if it is clear that the applicant will become unfit at some time in the future beyond this period of validity. The candidate will be advised of any likely future problem, but may well decide to continue flying. It is, therefore, axiomatic that there can be no significant difference between the medical standards at initial selection and subseqwuent later medical supervision of experienced aircrew.)

(The airman also has a responsibility in respect of his own fitness. Annex 1 requires that the licence privileges at any time when aware of a signicant decrease in medical fitness, which may affect flight safety. In the United Kingdom, this is incorporated in the Air Navigation Order and a further statutory requirement added that any incapacitating injury, or illness in excess of of 20 days' duration, must be notified to be the Civil Aviation Authority. The licence is thereby deemed to be suspended and restoration of the privileges requires a satisfactory Medical Examination.)

(A female pilot is similarly required to advise the Authority when she has reason to believe that she is pregnant. Some licensing authorities allow flying (but not as pilot in sole charge) during the middle trimesteer, provided obstetric advice remains favourable.)

(The wide range of individual variation must be considered whenever standards are being formulated or applied. I f laid down too rigidly some individuals will be excluded who, while not meeting the standards in all respects, might well be competent and capable of performing the required tasks safely under all conditions of flight.)

(Annex 1, para. 1.2.4.8, recognises the situation and provides for some flexibilitry to be applied in certain exceptional cases. Where, in the opinion of the Licensing Authority's medical advisers, flight safety will not be adversely affected when ability, skill and past experience are also taken into consideration, such flexibility may be recommended. Medical advisers may be consulted with specialists in the various fields of medicine who are also familiar with the flight environment; with flight branches of the Licensing Authority before reaching a conclusion. Special flight tests or simulating details may also be used in reaching a final decision.)

(By these means the 'accredited medical conclusion' is achieved as required by Annex 1. The final licence decision may result in unrestricted licensing, or certain licence limitations may be applied. Such limitations may restrict the airman to fixed wing aircraft only; to acting as a pilot in multi-crew aircraft only; or require more frequent medical scrutiny to maintain the licence.)

(In certain medical conditions, the carefully considered application of operational limitations, notably that of restriction to a multi-crew role only, may permit the retention of older and experienced aircrew with their greater safety record in an active capacity.)

(To be valid, all aircrew licences must contain a current certificate of medical fitness bearing the signature of a doctor specifically authorised by the Licencing Authority to conduct such examinations.)

(The Authorised Medical Examiner (AME) will have undergone specific training in aviation medicine and will subsequently be required to attend periodic seminars. Many will also be private pilots; familiar with the flight environment and requirements of the various types of air operations. In the UK all AME's conduct medical examinations for both the issue and renewal of the private pilot licence, but only a smaller proportion are authorised to undertake the periodic re-examination of professional aircrew. All medical examinations for the initial medical assessment of professional aircrew are conducted centrally. The geographical size of the UK, as in some other European countries, makes such a centralized arrangement possible.)

(Three classes of medical assessment are specified by ICAO in Annex 1 - each class details the physical and mental requirements, visual requirements and hearing standards applicable to the aircrew licence held or applied for.)

(However, Annex 1 recommends that the ALTP and SCPL medical certificates should have a period of validity not exceeding 1 year, this period reducing to 6 months only at the of 40 years).

(A private pilot's licence canot be held unless the applicant is 17 years of age or more and its recommended validity is for 2 years, this period reducing to 1 year after the age of 40).

(Class 3 assessment standards are to be met by air traffic controllers and are for all practical purposes identical with those for Class 1 assessments).

(The final decision on a candidate's medical fitness for the issue, or continuation, of an aircrew licence is the responsibility of the licensing authority, through its medical advisers).

(Decisions cannot always be made without additional specialized consultation and investigation. Ideally, the relevant specialist should be familiar with both medical requirements for licensing and the aviation environment. Thus, a suitably informed opinion may be given both to the candidate and to the authority).

(This ideal is not always attainable and conflict of opinion may arise between the specialist and the licencing authority. The comments following, which concern medical licence standards, should be read in conjunction with the relevant specialist chapters in this book, and also be amplified by reference to the Manual of Civil Aviation Medicine, ICAO 1985)

(The medical examination looks for freedom from disease or significant disorder which may impair flight safety. Ideally the examination should also contain a preventative element, identifying and modifying, where possible, risk factors for the development of future medical problems)

(A personal and family history should be documented. A history of heart disease, particularly in association with early sudden death, and of hypertension, diabetes, epilepsy or atopic illness, can be significant. Familial hearing defects or visual or problems, notably of myopia, glaucoma or colour vision defect, may indicate inherent problems in the special senses. Surgical procedures should be recorded and if necessary assessment deferred until full clinical details have been obtained.)

or, c. any wound, injury or sequelae from operation such as would entail a degree of functional incapacity which is likely to interfere with the safe operation of an aircraft or with the safe performance of his duties.'

(The general appearance, particularly that of weight in relation to height, sex and age should be assessed. Obesity by itself is not a reason for denial of a licence, but if excessive can impair mobility and can have implications for future health problems).

(All orthopaedic problems require special assessment. Abnormalities of, or loss of part of a limb may interfere with safe handling of aircraft controls. Loss of one or more digits with loss of dexterity and fine manipulative ability needs informed assessment. Loss of part of an upper or lower limb will be incompatible with a professional aviation career.)