ATCO.MED.A.001 Competent authority
Regulation (EU) 2015/340
For the purpose of this Part, the competent authority shall be:
(a) for aero-medical centres (AeMCs):
(1) the authority designated by the Member State where the AeMC has its principal place of business;
(2) the Agency, when the AeMC is located in a third country.
(b) for aero-medical examiners (AMEs):
(1) the authority designated by the Member State where the AMEs have their principal place of practice;
(2) if the principal place of practice of an AME is located in a third country, the authority designated by the Member State to which the AME applies for the issue of the certificate.
Regulation (EU) 2023/893
This Part, set out in this Annex, establishes the requirements for:
(a) the issue, validity, revalidation and renewal of the medical certificate required for exercising the privileges of an air traffic controller licence or of a student air traffic controller licence with the exception of synthetic training device instructor; and
[applicable until 3 August 2024 - Regulation (EU) 2015/340]
(a) the issue, validity, revalidation and renewal of the medical certificate required for exercising the privileges of an air traffic controller licence or of a student air traffic controller licence; and
[applicable from 4 August 2024 - Implementing Regulation (EU) 2023/893]
(b) the certification of AMEs to issue class 3 medical certificates.
Regulation (EU) 2015/340
For the purpose of this Part, the following definitions apply:
(a) ‘Accredited medical conclusion’ means the conclusion reached by one or more medical experts acceptable to the licensing authority, on the basis of objective and non-discriminatory criteria, for the purposes of the case concerned, in consultation with operational experts or other experts as necessary and including an operational risk assessment;
(b) ‘Aero-medical assessment’ means the conclusion on the medical fitness of an applicant based on the evaluation of the applicant's medical history and aero-medical examinations as required in this Part and further examinations and medical tests as necessary;
(c) ‘Aero-medical examination’ means inspection, palpation, percussion, auscultation or any other means of investigation especially for determining the medical fitness to exercise the privileges of the licence;
(d) ‘Eye specialist’ means an ophthalmologist or a vision care specialist qualified in optometry and trained to recognise pathological conditions;
(e) ‘Investigation’ means the assessment of a suspected pathological condition of an applicant by means of examinations and tests to verify the presence or absence of a medical condition;
(f) ‘Licensing authority’ means the competent authority of the Member State that issued the licence, or to which a person applies for the issue of a licence, or, when a person has not yet applied for the issue of a licence, the competent authority in accordance with this Part;
(g) ‘Limitation’ means a condition placed on the medical certificate that shall be complied with whilst exercising the privileges of the licence;
(h) ‘Refractive error’ means the deviation from emmetropia measured in dioptres in the most ametropic meridian, measured by standard methods;
(i) ‘Significant’ means a degree of a medical condition, the effect of which would prevent the safe exercise of the privileges of the licence.
ATCO.MED.A.015 Medical confidentiality
Regulation (EU) 2015/340
All persons involved in aero-medical examination, aero-medical assessment and certification shall ensure that medical confidentiality is respected at all times.
AMC1 ATCO.MED.A.015 Medical confidentiality
ED Decision 2015/010/R
To ensure medical confidentiality, all medical reports and records should be securely held with accessibility restricted to personnel authorised by the medical assessor.
ATCO.MED.A.020 Decrease in medical fitness
Regulation (EU) 2023/893
(a) Licence holders shall not exercise the privileges of their licence at any time when they:
(1) are aware of any decrease in their medical fitness which might render them unable to safely exercise those privileges;
(2) take or use any prescribed or non-prescribed medication which is likely to interfere with the safe exercise of the privileges of the licence;
(3) receive any medical, surgical or other treatment that is likely to interfere with the safe exercise of the privileges of the licence.
(b) In addition, holders of a class 3 medical certificate shall, without undue delay and before exercising the privileges of their licence, seek aero-medical advice when they:
(1) have undergone a surgical operation or invasive procedure;
(2) have commenced the regular use of any medication;
(3) have suffered any significant personal injury involving any incapacity to exercise the privileges of the licence;
(4) have been suffering from any significant illness involving any incapacity to exercise the privileges of the licence;
(5) are pregnant;
(6) have been admitted to hospital or medical clinic;
(7) first require correcting lenses.
In these cases the AeMC or AME shall assess the medical fitness of the licence holder or student air traffic controller and decide whether they are fit to resume the exercise of their privileges.
[applicable until 3 August 2024 - Regulation (EU) 2015/340]
b) In addition to requirements laid down in point (a), holders of a class 3 medical certificate shall, without undue delay and before exercising the privileges of their licence, seek aero-medical advice when they:
(1) have undergone a surgical operation or invasive procedure;
(2) have commenced the regular use of any medication;
(3) have suffered any significant personal injury involving any incapacity to exercise the privileges of the licence;
(4) have been suffering from any significant illness involving any incapacity to exercise the privileges of the licence;
(5) are aware of being pregnant;
(6) have been admitted to hospital or medical clinic;
(7) first require correcting lenses.
In these cases, the AeMC or AME shall assess the medical fitness of the licence holder or student air traffic controller and decide whether they are fit to resume the exercise of their privileges.
[applicable from 4 August 2024 - Implementing Regulation (EU) 2023/893]
GM1 ATCO.MED.A.020 Decrease in medical fitness
ED Decision 2015/010/R
MEDICATION — GUIDANCE FOR AIR TRAFFIC CONTROLLERS
(a) Any medication can cause side effects, some of which may impair the safe exercise of the privileges of the licence. Equally, symptoms of colds, sore throats, diarrhoea and other abdominal upsets may cause little or no problem whilst not exercising the privileges of the licence, but may distract the air traffic controller and degrade their performance whilst on duty. Therefore, one issue with medication and the safe exercise of the privileges of the licence is the underlying condition and, in addition, the symptoms may be compounded by the side effects of the medication prescribed or bought over the counter for treatment. This guidance material provides some help to air traffic controllers in deciding whether expert aero-medical advice by an AME, AeMC or Medical Assessor is needed.
(b) Before taking any medication and exercising the privileges of the licence, the following three basic questions should be satisfactorily answered:
(1) Do I feel fit to control?
(2) Do I really need to take medication at all?
(3) Have I given this particular medication a personal trial whilst not exercising the privileges of my licence to ensure that it will not have any adverse effects on my ability to exercise the privileges of my licence?
(c) Confirming the absence of adverse effects may well need expert aero-medical advice.
(d) The following are some widely used medicines with a description of their compatibility with the safe exercise of the privileges of the licence:
(1) Antibiotics. Antibiotics may have short-term or delayed side effects which can affect the performance of the air traffic controller. More significantly, however, their use usually indicates that an infection is present and, thus, the effects of this infection may mean that an air traffic controller is not fit to control and should obtain expert aero-medical advice.
(2) Anti-malaria drugs. The decision on the need for anti-malaria drugs depends on the geographical areas to be visited, and the risk that the air traffic controller has of being exposed to mosquitoes and of developing malaria. An expert medical opinion should be obtained to establish whether anti-malaria drugs are needed and what kind of drugs should be used. Most of the anti-malaria drugs (atovaquone plus proguanil, chloroquine, doxycycline) are compatible with the safe exercise of the privileges of the licence. However, adverse effects associated with mefloquine include insomnia, strange dreams, mood changes, nausea, diarrhoea and headaches. In addition, mefloquine may cause spatial disorientation and lack of fine coordination and is, therefore, not compatible with the safe exercise of the privileges of the licence.
(3) Antihistamines. Antihistamines can cause drowsiness. They are widely used in ‘cold cures’ and in treatment of hay fever, asthma and allergic rashes. They may be in tablet form or a constituent of nose drops or sprays. In many cases, the condition itself may preclude the safe exercise of the privileges of the licence, so that, if treatment is necessary, expert aero-medical advice should be sought so that so-called non-sedative antihistamines, which do not degrade human performance, can be prescribed.
(4) Cough medicines. Antitussives often contain codeine, dextromethorfan or pseudo-ephedrine which are not compatible with the safe exercise of the privileges of the licence. However, mucolytic agents (e.g. carbocysteine) are well tolerated and are compatible with the safe exercise of the privileges of the licence.
(5) Decongestants. Nasal decongestants with no effect on alertness may be compatible with the safe exercise of the privileges of the licence.
(6) Nasal corticosteroids are commonly used to treat hay fever, and are compatible with the safe exercise of the privileges of the licence.
(7)
(i) Common pain killers and antifebrile drugs. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and paracetamol, commonly used to treat pain, fever or headaches, may be compatible with the safe exercise of the privileges of the licence. However, the air traffic controller should give affirmative answers to the three basic questions in paragraph (b) before using the medication and exercising the privileges of the licence.
(ii) Strong analgesics. The more potent analgesics including codeine are opiate derivatives, and may produce a significant decrement in human performance and, therefore, are not compatible with the safe exercise of the privileges of the licence.
(8) Anti-ulcer medicines. Gastric secretion inhibitors such as H2 antagonists (e.g. ranitidine, cimetidine) or proton pump inhibitors (e.g. omeprazole) may be acceptable after diagnosis of the pathological condition. It is important to seek for the medical diagnosis and not to only treat the dyspeptic symptoms.
(9) Anti-diarrhoeal drugs. Loperamide is one of the more common anti-diarrhoeal drugs and is usually safe to take whilst exercising the privileges of the licence. However, the diarrhoea itself often makes the air traffic controller unable to exercise the privileges of the licence.
(10) Hormonal contraceptives and hormone replacement therapy usually have no adverse effects and are compatible with the safe exercise of the privileges of the licence.
(11) Erectile dysfunction medication. This medication may cause disturbances in colour vision and dizziness. There should be at least six hours between taking sildenafil and exercising the privileges of the licence; and 36 hours between taking vardenafil or tadalafil and exercising the privileges of the licence.
(12) Smoking cessation. Nicotine replacement therapy may be acceptable. However, other medication affecting the central nervous system (buproprion, varenicline) is not acceptable for air traffic controllers.
(13) High blood pressure medication. Most anti-hypertensive drugs are compatible with the safe exercise of the privileges of the licence. However, if the level of blood pressure is such that drug therapy is required, the air traffic controller should be monitored for any side effects before exercising the privileges of the licence. Therefore, consultation with the AME, AeMC or Medical Assessor as applicable, is needed.
(14) Asthma medication. Asthma has to be clinically stable before an air traffic controller can return to exercising the privileges of the licence. The use of respiratory aerosols or powders, such as corticosteroids, beta-2-agonists or chromoglycic acid may be compatible with the safe exercise of the privileges of the licence. However, the use of oral steroids or theophylline derivatives is usually incompatible with the safe exercise of the privileges of the licence. Air traffic controllers using medication for asthma should consult an AME, AeMC, or Medical Assessor, as applicable.
(15) Tranquillisers, anti-depressants and sedatives. The inability to react, due to the use of this group of medicines, together with the underlying condition for which these medications have been prescribed, will almost certainly mean that the mental state of an air traffic controller is not compatible with the safe exercise of the privileges of the licence. Air traffic controllers using tranquillisers, anti-depressants and sedatives should consult an AME, AeMC, or Medical Assessor, as applicable.
(16) Sleeping tablets. Sleeping tablets dull the senses, may cause confusion and slow reaction times. The duration of effect may vary from individual to individual and may be unduly prolonged. Air traffic controllers using sleeping tablets should consult an AME, AeMC, or Medical Assessor, as applicable.
(17) Melatonin. Melatonin is a hormone that is involved with the regulation of the circadian rhythm. In some countries it is a prescription medicine, whereas in most other countries it is regarded as a ‘dietary supplement’ and can be bought without any prescription. The results from the efficiency of melatonin in treatment of jet lag or sleep disorders have been contradictory. Air traffic controllers using melatonin should consult an AME, AeMC, or Medical Assessor, as applicable.
(18) Coffee and other caffeinated drinks may be acceptable, but excessive coffee drinking may have harmful effects, including disturbance of the heart’s rhythm. Other stimulants including caffeine pills, amphetamines, etc. (often known as ‘pep’ pills) used to maintain wakefulness or suppress appetite can be habit forming. Susceptibility to different stimulants varies from one individual to another, and all may cause dangerous overconfidence. Overdosage causes headaches, dizziness and mental disturbance. These other stimulants should not be used.
(19) Anaesthetics. Following local, general, dental and other anaesthetics, a period of time should elapse before returning to exercising the privileges of the licence. The period will vary considerably from individual to individual, but an air traffic controller should not exercise the privileges of the licence for at least 12 hours after a local anaesthetic, and for at least 48 hours after a general, spinal or epidural anaesthetic.
(e) Many preparations on the market nowadays contain a combination of medicines. It is, therefore, essential that if there is any new medication or dosage, however slight, the effect should be observed by the air traffic controller whilst not exercising the privileges of the licence. It should be noted that medication which would not normally affect air traffic controller performance may do so in individuals who are ‘oversensitive’ to a particular preparation. Individuals are, therefore, advised not to take any medicines before or whilst exercising the privileges of their licence unless they are completely familiar with their effects on their own bodies. In cases of doubt, air traffic controllers should consult an AME, AeMC, or Medical Assessor, as applicable.
(f) Other treatments
Alternative or complementary medicine, such as acupuncture, homeopathy, hypnotherapy and several other disciplines, is developing and gaining greater credibility. Such treatments are more acceptable in some States than others. There is a need to ensure that ‘other treatments’, as well as the underlying condition, are declared and considered by the AME, AeMC, or Medical Assessor, as applicable, for assessing fitness.
ATCO.MED.A.025 Obligations of AeMC and AME
Regulation (EU) 2015/340
(a) When conducting aero-medical examinations and assessments as required in this Part, the AeMC or AME shall:
(1) ensure that communication with the applicant can be established without language barriers;
(2) make the applicant aware of the consequences of providing incomplete, inaccurate or false statements on their medical history;
(3) notify the licensing authority if the applicant provides incomplete, inaccurate or false statements on their medical history;
(4) notify the licensing authority if the applicant withdraws the application for a medical certificate at any stage of the process.
(b) After completion of the aero-medical examinations and assessments, the AeMC and AME shall:
(1) advise the applicant whether fit, unfit or referred to the licensing authority;
(2) inform the applicant of any limitation placed on the medical certificate; and
(3) if the applicant has been assessed as unfit, inform him/her of his/her right of a review of the decision; and
(4) submit without delay to the licensing authority a signed, or electronically authenticated, report containing the detailed results of the aero-medical examination and assessment for the medical certificate and a copy of the application form, the examination form and the medical certificate; and
(5) inform the applicant of their responsibility in the case of decrease in medical fitness as specified in ATCO.MED.A.020.
(c) AeMCs and AMEs shall maintain records with details of aero-medical examinations and assessments performed in accordance with this Part and their results for a minimum period of 10 years, or for a period as determined by national legislation if this is longer.
(d) AeMCs and AMEs shall submit to the medical assessor of the competent authority, upon request, all aero-medical records and reports, and any other relevant information when required for:
(1) medical certification;
(2) oversight functions.
AMC1 ATCO.MED.A.025 Obligations of AeMC and AME
ED Decision 2015/010/R
(a) If the aero-medical examination is carried out by two or more AMEs, only one of them should be responsible for coordinating the results of the examination, evaluating the findings with regard to medical fitness and signing the report.
(b) The applicant should be made aware that the associated medical certificate may be suspended or revoked if the applicant provides incomplete, inaccurate or false statements on their medical history to the AME or AeMC.
(c) The AME or AeMC should give advice to the applicant on treatment and preventive measures if, during the course of the examination, medical conditions which may endanger the medical fitness of the applicant in the future are found.
GM1 ATCO.MED.A.025 Obligations of AeMC and AME
ED Decision 2015/010/R
GUIDELINES FOR THE AEMC AND AME CONDUCTING THE AERO-MEDICAL EXAMINATIONS AND ASSESSMENTS FOR CLASS 3 MEDICAL CERTIFICATES
(a) Before performing the aero-medical examination, the AeMC or AME should:
(1) verify the applicant’s identity by checking their identity card, passport, driving licence or other official document containing a photograph of the applicant;
(2) obtain details of the applicant’s licence from the applicant’s licensing authority if they do not have their licence with them;
(3) obtain details of the applicant’s most recent medical certificate from the applicant’s licensing authority if they do not have their certificate with them;
(4) in the case of a specific medical examination (SIC) on the existing medical certificate, obtain details of the specific medical condition and any associated instructions from the applicant’s licensing authority. This could include, for example, a requirement to undergo a specific examination or test;
(5) except for initial applicants, ascertain, from the previous medical certificate, which routine medical test(s) should be conducted, for example electrocardiogram (ECG);
(6) provide the applicant with the application form for a medical certificate and the instructions for its completion and ask the applicant to complete the form but not to sign it yet;
(7) go through the form with the applicant and give information to help the applicant understand the significance of the entries and ask any questions which might help the applicant to recall important historical medical data; and
(8) verify that the form is complete and legible, ask the applicant to sign and date the form and then sign it as well. If the applicant declines to complete the application form fully or declines to sign the declaration consent to the release of medical information, inform the applicant that it may not be possible to issue a medical certificate regardless of the outcome of the clinical examination.
(b) Once all the items in (a) have been addressed, the AeMC or AME should:
(1) perform the aero-medical examination of the applicant in accordance with the applicable rules;
(2) arrange for additional specialist medical examinations, such as otorhinolaryngology or ophthalmology, to be conducted as applicable and obtain the associated report forms or reports;
(3) complete the aero-medical examination report form in accordance with the associated instructions for completion; and
(4) ensure that all of the report forms are complete, accurate and legible.
(c) Once all the actions in (b) have been carried out, the AeMC or AME should review the report forms and:
(1) if satisfied that the applicant meets the applicable medical requirements as set out in this Part, issue a medical certificate, with limitations if necessary. The applicant should sign the certificate once signed by the AeMC or AME; or
(2) if the applicant does not meet the applicable medical requirements or if the fitness of the applicant is in doubt:
(i) refer the decision on medical fitness to the licensing authority as indicated in ATCO.MED.B.001; or
(ii) deny issuance of a medical certificate, explain the reason(s) for denial to the applicant and inform them of their right of a review according to the procedures of the competent authority.
(d) The AeMC or AME should send the documents as required by ATCO.MED.A.025(b) to the applicant’s licensing authority within five days from the date of the aero-medical examination. If a medical certificate has been denied or the decision has been referred, the documents should be sent to the licensing authority on the same day that the denial or referral decision is reached.