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AVIATION MEDICINE (MED) SECTION

FREQUENTLY ASKED QUESTIONS (FAQs)


Medical requirements for obtaining and maintaining a licence

What are the medical requirements for aviation licences?
What are the visual requirements for commercial pilots?
Can a colour blind person have either a private pilot, a commercial pilot or an air traffic controller licence according to the ICAO regulations?
What are the latest changes on regulations about coronary angioplasty and coronary artery by-pass grafting (CABG)?
Can a person suffering from sickle cell disease or thallassaemia become a professional pilot?
What is the age limit for flight crew?

Communicable diseases/avian influenza

ICAO Guidelines for States
Influenza A(H1N1) and the aviation sector, presentation by Dr. Anthony Evans, Chief, Aviation Medicine Section, International Civil Aviation Organization (pdf)
Managing communicable disease in aviation
Severe Acute Respiratory Syndrome (SARS)

Medical facilities

What are the ICAO Standards and Recommended Practices for medical facilities at international airports?

Education and training

Where can I find information on education and training in aviation medicine?
Link to the website of the Aviation Medicine Section (MED)
 

What are the medical requirements for aviation licences?

ICAO sets the medical requirements for aviation licences, but each State is able to interpret these in its own way. For example, this means that whilst an applicant for, or holder of, a professional pilot licence can expect to undergo a periodic medical examination a least every 12 months, an individual who has a medical problem might be assessed differently in different States, depending on the specific policy in place in that particular State.

To become a professional pilot or an air traffic controller, an applicant must be in normal good health (including normal hearing, normal vision and normal colour perception). However, certain medical conditions are permitted by some States, depending on individual circumstances and when in doubt about the importance of such a condition, it is always advisable to contact the Chief Medical Officer of the national Licensing Authority.

The medical Standards and Recommended Practices can be found in Annex 1 — Personnel Licensing (mainly in Chapter 6). Annex 1 (Order No. AN 1) can be purchased directly online from ICAO through the Document Sales Unit.


What are the visual requirements for commercial pilots?

There is no dioptre limit for medical certification of any Class; only visual performance needs to be considered. Distant visual acuity with or without correction shall be 6/9 (20/30) or better in each eye separately, and binocular visual acuity shall be 6/6 (20/20) or better. No limits apply to uncorrected visual acuity. In cases where the uncorrected visual acuity is worse than 6/60 (20/200), a full ophthalmic examination is required, the purpose of which is (1) to ascertain normal visual performance, and (2) to identify any significant pathology.

The regulations permit the use of contact lenses, and applicants who have undergone refractive surgery such as keratotomy, LASIK, etc. may be assessed as fit if they are "free from those sequelae which are likely to interfere with the safe exercise of their licence."

Some States, notably those in Europe, and some airlines, have more stringent requirements.

It is recommended that prospective applicants contact (a) the national Licensing Authority and (b) the medical director of the airline to which they intend to apply for training or employment, to ensure they are aware of any medical requirements.


Can a colour blind person have either a private pilot, a commercial pilot or an air traffic controller licence according to the ICAO regulations?

It is very rare for someone to be colour "blind" i.e. cannot see any colour at all. Most of those with a deficiency can see some colours quite well but not all colours or all shades of colour. The ICAO medical provisions in Annex 1 — Personnel Licensing, state that an applicant 'shall be tested for the ability to correctly identify a series of pseudoisochromatic plates'. Such a test displays different numbers (or shapes or letters) that are made up of dots that are coloured differently from background dots. Colours are chosen so that individuals with a colour vision deficiency cannot differentiate the number from the background.

Individuals who fail this test can nevertheless be accepted for licensing if they can "readily distinguish the colours used in air navigation and correctly identify aviation coloured lights". Depending on the country in which the application is made, this secondary test may take the form of a device (called a "lantern") that requires an applicant to identify different coloured lights e.g. red, green and white and sometimes, depending on the exact lantern type, additional colours. Alternatively, a practical test using a signal light, such as used on airports to signal to aircraft, may be utilised. As different countries apply different tests it is necessary to inquire of a particular Licensing Authority the details of the test it employs.

For private pilots only, an applicant who fails both tests can be licensed as long as his/her licence is restricted "Valid daytime only".


What are the latest changes on regulations about coronary angioplasty and coronary artery by-pass grafting (CABG)?

The current regulations can be found in Chapter 6 of Annex 1 — Personnel Licensing, paragraph 6.3.2.5 (6.4.2.5. and 6.5.2.5). The paragraph is identical for all classes of medical assessment and states:

6.3.2.5.1 An applicant who has undergone coronary by-pass grafting or angioplasty (with or without stenting) or other cardiac intervention or who has a history of myocardial infarction or who suffers from any other potentially incapacitating cardiac condition shall be assessed as unfit unless the applicant's cardiac condition has been investigated and evaluated in accordance with best medical practice and is assessed not likely to interfere with the safe exercise of the applicant's licence or rating privileges.

Guidance on this Standard is being rewritten, but a reasonable assessment is as follows:

Applicants who have undergone bypass grafting or coronary angioplasty may be considered for recertification, limited to multi-crew professional operations, no sooner than 6 months after surgery provided:

  1. they are asymptomatic without cardio-active treatment;
  2. an exercise ECG shows no signs of ischaemia;
  3. the left ventricular ejection fraction is normal or near normal (more than 50%);
  4. there is no obstructive lesion of more than 50% in any major epicardial artery or branch thereof, whether a native vessel, a graft or a vessel that has undergone angioplasty or stenting;
  5. cardio-vascular risk factors are dealt with satisfactorily (including smoking cessation); and
  6. annual follow-up by cardiologist is undertaken.

A more flexible interpretation may be appropriate for professional pilots not carrying passengers, or for private pilots.


Can a person suffering from sickle cell disease or thallassaemia become a professional pilot?

Since the decision will be taken by the Aviation Medical Section of the Licensing Authority in the State of application, the question should be addressed to the Chief Medical Officer of the national Licensing Authority.

Annex 1 — Personnel Licensing states:

6.3.2.17 Applicants with diseases of the blood and/or the lymphatic system shall be assessed as unfit, unless adequately investigated and their condition found unlikely to interfere with the safe exercise of their licence and rating privileges.
 
Note. — Sickle cell trait and other haemoglobinopathic traits are usually compatible with fit assessment.

What are the ICAO Standards and Recommended Practices for medical facilities at international airports?

While provisions on medical facilities, ambulances and hospitals are mentioned in the ICAO Annexes and other pertinent materials, the decision on what to provide is left to the local authorities.

However, some advice and guidance can be found in the following ICAO documents:

  1. Annex 14 — Aerodromes, in Chapter 9, paragraph 9.1, that an emergency plan shall be established and that the plan shall coordinate the response of all existing agencies, including medical and ambulance services.
  2. In Doc 9137-AN/898 — Manual of Airport Services, more detailed advice is given in Part 1 – Rescue and Fire Fighting – and in particular, in Part 7 – Airport Emergency Planning.
  3. Annex 9 — Facilitation states that Contracting States shall comply with the International Health Regulations (IHR) of the World Health Organization. The IHR outlines the organization of a medical and health service in an international airport.

The WHO document Guide to Hygiene and Sanitation in Aviation (pdf) by James Bailey, 1977, pp. 1-96, also discusses the subject in-depth.