Regulation (EU) 2015/340
Applicants shall be free from any of the following that would entail a degree of functional incapacity which is likely to interfere with the safe performance of duties or could render the applicant likely to become suddenly unable to exercise the privileges of the licence safely:
(1) abnormality, congenital or acquired;
(2) active, latent, acute or chronic disease or disability;
(3) wound, injury or sequelae from operation;
(4) effect or side effect of any prescribed or non-prescribed therapeutic, diagnostic or preventive medication taken.
ATCO.MED.B.010 Cardiovascular system
Regulation (EU) 2015/340
(a) Examination:
(1) A standard 12-lead resting electrocardiogram (ECG) and report shall be completed at the examination for the initial issue of a medical certificate and then:
(i) every 4 years until the age of 30;
(ii) at all revalidation or renewal examinations thereafter; and
(iii) when clinically indicated.
(2) An extended cardiovascular assessment shall be completed:
(i) at the first revalidation or renewal examination after the age of 65;
(ii) every 4 years thereafter; and
(iii) when clinically indicated.
(3) Estimation of serum lipids, including cholesterol, shall be required at the examination for the initial issue of a medical certificate, at the first examination after having reached the age of 40, and when clinically indicated.
(b) Cardiovascular system — General:
(1) Applicants with any of the following conditions shall be assessed as unfit:
(i) aneurysm of the thoracic or supra-renal abdominal aorta before surgery;
(ii) significant functional or symptomatic abnormality of any of the heart valves;
(iii) heart or heart/lung transplantation.
(2) Applicants with an established history or diagnosis of any of the following conditions shall be referred to the licensing authority before a fit assessment may be considered:
(i) peripheral arterial disease before or after surgery;
(ii) aneurysm of the thoracic or supra-renal abdominal aorta after surgery;
(iii) aneurysm of the infra-renal abdominal aorta before or after surgery;
(iv) functionally insignificant cardiac valvular abnormalities;
(v) after cardiac valve surgery;
(vi) abnormality of the pericardium, myocardium or endocardium;
(vii) congenital abnormality of the heart, before or after corrective surgery;
(viii) recurrent vasovagal syncope;
(ix) arterial or venous thrombosis;
(x) pulmonary embolism;
(xi) cardiovascular condition requiring systemic anticoagulant therapy.
(c) Blood pressure:
(1) Blood pressure shall be recorded at each examination.
(2) The applicant's blood pressure shall be within normal limits.
(3) Applicants shall be assessed as unfit when:
(i) they have symptomatic hypotension; or
(ii) when their blood pressure at examination consistently exceeds 160 mmHg systolic and/or 95 mmHg diastolic, with or without treatment.
(4) The initiation of medication for the control of blood pressure shall require a period of temporary unfit assessment to establish the absence of significant side effects.
(d) Coronary artery disease:
(1) Applicants with any of the following conditions shall be assessed as unfit:
(i) symptomatic coronary artery disease;
(ii) symptoms of coronary artery disease controlled by medication.
(2) Applicants with any of the following conditions shall be referred to the licensing authority and undergo cardiological evaluation to exclude myocardial ischaemia before a fit assessment may be considered:
(i) suspected myocardial ischaemia;
(ii) asymptomatic minor coronary artery disease requiring no anti-anginal treatment.
(3) Applicants with a history or diagnosis of any of the following conditions shall be referred to the licensing authority and undergo a cardiological evaluation before a fit assessment may be considered:
(i) myocardial ischaemia;
(ii) myocardial infarction;
(iii) revascularisation and stenting for coronary artery disease.
(e) Rhythm/Conduction disturbances:
(1) Applicants for a class 3 medical certificate with any significant disturbance of cardiac conduction or rhythm, intermittent or established shall be referred to the licensing authority and undergo cardiological evaluation with satisfactory results before a fit assessment may be considered. These disturbances shall include any of the following:
(i) disturbance of supraventricular rhythm, including intermittent or established sinoatrial dysfunction, atrial fibrillation and/or flutter and asymptomatic sinus pauses;
(ii) complete left bundle branch block;
(iii) Mobitz type 2 atrioventricular block;
(iv) broad and/or narrow complex tachycardia;
(v) ventricular pre-excitation;
(vi) asymptomatic QT prolongation;
(vii) Brugada pattern on electrocardiography.
(2) Applicants with any of the conditions listed in points (i) to (viii) may be assessed as fit in the absence of any other abnormality and subject to satisfactory cardiological evaluation:
(i) incomplete bundle branch block;
(ii) complete right bundle branch block;
(iii) stable left axis deviation;
(iv) asymptomatic sinus bradycardia;
(v) asymptomatic sinus tachycardia;
(vi) asymptomatic isolated uniform supra-ventricular or ventricular ectopic complexes;
(vii) first degree atrioventricular block;
(viii) Mobitz type 1 atrioventricular block.
(3) Applicants with a history of any of the following conditions shall be referred to the licensing authority and undergo cardiological evaluation with satisfactory results before a fit assessment may be considered:
(i) ablation therapy;
(ii) pacemaker implantation.
(4) Applicants with any of the following conditions shall be assessed as unfit:
(i) symptomatic sinoatrial disease;
(ii) complete atrioventricular block;
(iii) symptomatic QT prolongation;
(iv) an automatic implantable defibrillating system;
(v) a ventricular anti-tachycardia pacemaker.
AMC1 ATCO.MED.B.010 Cardiovascular system
ED Decision 2015/010/R
(a) Electrocardiography
(1) An exercise electrocardiogram (ECG) when required as part of a cardiovascular assessment should be symptom-limited and completed to a minimum of Bruce Stage IV or equivalent.
(2) Reporting of resting and exercise ECGs should be carried out by the AME or an appropriate specialist.
(b) General
(1) Cardiovascular risk factor assessment
(i) Serum/plasma lipid estimation is case finding and significant abnormalities should require investigation and management under the supervision of the AeMC or AME in consultation with the licensing authority if necessary.
(ii) An accumulation of risk factors (smoking, family history, lipid abnormalities, hypertension, etc.) should require cardiovascular evaluation by the AeMC or AME in consultation with the licensing authority if necessary.
(2) Extended cardiovascular assessment
(i) The extended cardiovascular assessment should be undertaken at an AeMC or by a cardiologist.
(ii) The extended cardiovascular assessment should include an exercise ECG or other test that will provide equivalent information.
(c) Peripheral arterial disease
Applicants with peripheral arterial disease, before or after surgery, should undergo satisfactory cardiological evaluation including an exercise ECG and 2D echocardiography. Further tests may be required which should show no evidence of myocardial ischaemia or significant coronary artery stenosis. A fit assessment may be considered provided:
(1) the exercise ECG is satisfactory; and
(2) there is no sign of significant coronary artery disease or evidence of significant atheroma elsewhere, and no functional impairment of the end organ supplied.
(d) Aortic aneurysm
(1) Applicants with an aneurysm of the infra-renal abdominal aorta may be assessed as fit following a satisfactory cardiological evaluation.
(2) Applicants may be assessed as fit after surgery for an aneurysm of the thoracic or abdominal aorta if the blood pressure and cardiovascular evaluation are satisfactory. Regular evaluations by a cardiologist should be carried out.
(e) Cardiac valvular abnormalities
(1) Applicants with previously unrecognised cardiac murmurs should require cardiological evaluation. If considered significant, further investigation should include at least 2D Doppler echocardiography.
(2) Applicants with minor cardiac valvular abnormalities may be assessed as fit by the licensing authority. Applicants with significant abnormality of any of the heart valves should be assessed as unfit.
(3) Aortic valve disease
(i) Applicants with bicuspid aortic valve may be assessed as fit if no other cardiac or aortic abnormality is demonstrated. Regular cardiological follow-up, including 2D Doppler echocardiography, may be required.
(ii) Applicants with mild aortic stenosis may be assessed as fit. Annual cardiological follow-up may be required and should include 2D Doppler echocardiography.
(iii) Applicants with aortic regurgitation may be assessed as fit only if regurgitation is minor and there is no evidence of volume overload. There should be no demonstrable abnormality of the ascending aorta on 2D Doppler echocardiography. Cardiological follow-up including 2D Doppler echocardiography may be required.
(4) Mitral valve disease
(i) Applicants with rheumatic mitral stenosis may only be assessed as fit in favourable cases after cardiological evaluation including 2D echocardiography.
(ii) Applicants with uncomplicated minor regurgitation may be assessed as fit. Regular cardiological follow-up including 2D echocardiography may be required.
(iii) Applicants with mitral valve prolapse and mild mitral regurgitation may be assessed as fit.
(iv) Applicants with evidence of volume overloading of the left ventricle demonstrated by increased left ventricular end-diastolic diameter should be assessed as unfit.
(f) Valvular surgery
Applicants with cardiac valve replacement/repair should be assessed as unfit. After a satisfactory cardiological evaluation, fit assessment may be considered.
(1) Asymptomatic applicants may be assessed as fit by the licensing authority six months after valvular surgery subject to:
(i) normal valvular and ventricular function as judged by 2D Doppler echocardiography;
(ii) satisfactory symptom-limited exercise ECG or equivalent;
(iii) demonstrated absence of coronary artery disease unless this has been satisfactorily treated by re-vascularisation;
(iv) no cardioactive medication is required;
(v) annual cardiological follow-up to include an exercise ECG and 2D Doppler echocardiography. Longer periods may be acceptable once a stable condition has been confirmed by cardiological evaluations.
(2) Applicants with implanted mechanical valves may be assessed as fit subject to documented exemplary control of their anti-coagulant therapy. Age factors should form part of the risk assessment.
(g) Thromboembolic disorders
Applicants with arterial or venous thrombosis or pulmonary embolism should be assessed as unfit during the first six months of anticoagulation. A fit assessment, with a limitation if necessary, may be considered by the licensing authority after six months of stable anticoagulation. Anticoagulation should be considered stable if, within the last six months, at least five international normalised ratio (INR) values are documented, of which at least four are within the INR target range and the haemorrhagic risk is acceptable. In cases of anticoagulation medication not requiring INR monitoring, a fit assessment may be considered after review by the licensing authority after a period of three months. Applicants with pulmonary embolism should also be evaluated by a cardiologist. Following cessation of anticoagulant therapy, for any indication, applicants should undergo a reassessment by the licensing authority.
(h) Other cardiac disorders
(1) Applicants with a primary or secondary abnormality of the pericardium, myocardium or endocardium should be assessed as unfit. A fit assessment may be considered following complete resolution and satisfactory cardiological evaluation which may include 2D Doppler echocardiography, exercise ECG, 24-hour ambulatory ECG, and/or myocardial perfusion scan or equivalent test. Coronary angiography may be indicated. Regular cardiological follow-up may be required.
(2) Applicants with a congenital abnormality of the heart should be assessed as unfit. Applicants following surgical correction or with minor abnormalities that are functionally unimportant may be assessed as fit following cardiological assessment. No cardioactive medication is acceptable. Investigations may include 2D Doppler echocardiography, exercise ECG and 24-hour ambulatory ECG. Regular cardiological follow-up may be required.
(i) Syncope
(1) Applicants with a history of recurrent episodes of syncope should be assessed as unfit. A fit assessment may be considered after a sufficient period of time without recurrence provided cardiological evaluation is satisfactory.
(2) A cardiological evaluation should include:
(i) a satisfactory symptom exercise ECG. If the exercise ECG is abnormal, a myocardial perfusion scan or equivalent test should be required;
(ii) a 2D Doppler echocardiogram showing neither significant selective chamber enlargement nor structural or functional abnormality of the heart, valves or myocardium;
(iii) a 24-hour ambulatory ECG recording showing no conduction disturbance, complex or sustained rhythm disturbance or evidence of myocardial ischaemia;
(iv) a tilt test carried out to a standard protocol showing no evidence of vasomotor instability.
(3) Neurological review should be required.
(j) Blood pressure
(1) Anti-hypertensive treatment should be agreed by the licensing authority. Medication may include:
(i) non-loop diuretic agents;
(ii) Angiotensin Converting Enzyme (ACE) inhibitors;
(iii) angiotensin II receptor blocking agents;
(iv) long-acting slow channel calcium blocking agents;
(v) certain (generally hydrophilic) beta-blocking agents.
(2) Following initiation of medication for the control of blood pressure, applicants should be re-assessed to verify that the treatment is compatible with the safe exercise of the privileges of the licence.
(k) Coronary artery disease
(1) Applicants with chest pain of an uncertain cause should undergo a full investigation before a fit assessment may be considered. Applicants with angina pectoris should be assessed as unfit, whether or not it is abolished by medication.
(2) Applicants with suspected asymptomatic coronary artery disease should undergo a cardiological evaluation including exercise ECG. Further tests (myocardial perfusion scanning, stress echocardiography, coronary angiography or equivalent) may be required, which should show no evidence of myocardial ischaemia or significant coronary artery stenosis.
(3) After an ischaemic cardiac event, including revascularisation, applicants without symptoms should have reduced any vascular risk factors to an appropriate level. Medication, when used to control cardiac symptoms, is not acceptable. All applicants should be on acceptable secondary prevention treatment.
(i) A coronary angiogram obtained around the time of, or during, the ischaemic myocardial event and a complete, detailed clinical report of the ischaemic event and of any operative procedures should be available.
(A) there should be no stenosis more than 50 % in any major untreated vessel, in any vein or artery graft or at the site of an angioplasty/stent, except in a vessel subtending a myocardial infarction;
(B) the whole coronary vascular tree should be assessed as satisfactory by a cardiologist, and particular attention should be paid to multiple stenoses and/or multiple revascularisations;
(C) an untreated stenosis greater than 30 % in the left main or proximal left anterior descending coronary artery should not be acceptable.
(ii) At least six months from the ischaemic myocardial event, including revascularisation, the following investigations should be completed:
(A) an exercise ECG showing neither evidence of myocardial ischaemia nor rhythm or conduction disturbance;
(B) an echocardiogram or equivalent test showing satisfactory left ventricular function with no important abnormality of wall motion (such as dyskinesia or akinesia) and a left ventricular ejection fraction of 50 % or more;
(C) in cases of angioplasty/stenting, a myocardial perfusion scan or equivalent test, which should show no evidence of reversible myocardial ischaemia. If there is any doubt about myocardial perfusion, in other cases (infarction or bypass grafting), a perfusion scan should also be required;
(D) further investigations, such as a 24-hour ECG, may be necessary to assess the risk of any significant rhythm disturbance.
(iii) Follow-up should be conducted annually (or more frequently, if necessary) to ensure that there is no deterioration of the cardiovascular status. It should include a cardiological evaluation, exercise ECG and cardiovascular risk assessment. Additional investigations may be required.
(iv) After coronary artery vein bypass grafting, a myocardial perfusion scan or equivalent test should be performed on clinical indication, and in all cases within five years from the procedure.
(v) In all cases, coronary angiography, or an equivalent test, should be considered at any time if symptoms, signs or non-invasive tests indicate myocardial ischaemia.
(vi) Applicants may be assessed as fit after successful completion of the three-month or subsequent review.
(l) Rhythm and conduction disturbances
(1) Applicants with any significant rhythm or conduction disturbance may be assessed as fit after cardiological evaluation and with appropriate follow-up. Such evaluation should include:
(i) exercise ECG which should show no significant abnormality of rhythm or conduction, and no evidence of myocardial ischaemia. Withdrawal of cardioactive medication prior to the test should be required;
(ii) 24-hour ambulatory ECG which should demonstrate no significant rhythm or conduction disturbance;
(iii) 2D Doppler echocardiogram which should show no significant selective chamber enlargement or significant structural or functional abnormality, and a left ventricular ejection fraction of at least 50 %.
Further evaluation may include:
(iv) 24-hour ECG recording repeated as necessary;
(v) electrophysiological study;
(vi) myocardial perfusion imaging or equivalent test;
(vii) cardiac magnetic resonance imaging (MRI) or equivalent test;
(viii) coronary angiogram or equivalent test.
(2) Applicants with supraventricular or ventricular ectopic complexes on a resting ECG may require no further evaluation, provided the frequency can be shown to be no greater than one per minute, for example on an extended ECG strip.
Applicants with asymptomatic isolated uniform ventricular ectopic complexes may be assessed as fit, but frequent or complex forms require full cardiological evaluation.
(3) Where anticoagulation is needed for a rhythm disturbance, a fit assessment may be considered if the haemorrhagic risk is acceptable and the anticoagulation is stable. Anticoagulation should be considered stable if, within the last six months, at least five INR values are documented, of which at least four are within the INR target range. In cases of anticoagulation medication not requiring INR monitoring, a fit assessment with an appropriate limitation may be considered after review by the licensing authority after a period of three months.
(4) Ablation
(i) Applicants who have undergone ablation therapy should be assessed as unfit for a minimum period of two months.
(ii) A fit assessment may be considered following successful catheter ablation provided an electrophysiological study (EPS) demonstrates satisfactory control has been achieved.
(iii) Where EPS is not performed, longer periods of unfitness and cardiological follow-up should be considered.
(iv) Follow-up should include a cardiological review.
(5) Supraventricular arrhythmias
Applicants with significant disturbance of supraventricular rhythm, including sinoatrial dysfunction, whether intermittent or established, should be assessed as unfit. A fit assessment may be considered if cardiological evaluation is satisfactory.
(i) For initial applicants with atrial fibrillation/flutter, a fit assessment should be limited to those with a single episode of arrhythmia which is considered to be unlikely to recur.
(ii) For revalidation, applicants may be assessed as fit if cardiological evaluation is satisfactory and the stroke risk is sufficiently low. A fit assessment may be considered after a period of stable anticoagulation as prophylaxis, after review by the licensing authority. Anticoagulation should be considered stable if, within the last six months, at least five INR values are documented, of which at least four are within the INR target range. In cases of anticoagulation medication not requiring INR monitoring, a fit assessment may be considered after review by the licensing authority after a period of three months.
(iii) Applicants with asymptomatic sinus pauses up to 2.5 seconds on a resting ECG may be assessed as fit if exercise ECG, 2D echocardiography and 24-hour ambulatory ECG are satisfactory.
(iv) Applicants with symptomatic sino-atrial disease should be assessed as unfit.
(6) Mobitz type 2 atrio-ventricular block
Applicants with Mobitz type 2 AV block may be assessed as fit after a full cardiological evaluation confirms the absence of distal conducting tissue disease.
(7) Complete right bundle branch block
Applicants with complete right bundle branch block should require cardiological evaluation on first presentation.
(8) Complete left bundle branch block
A fit assessment may be considered as follows:
(i) Initial applicants may be assessed as fit after full cardiological evaluation showing no pathology. Depending on the clinical situation, a period of stability may be required.
(ii) Applicants for revalidation or renewal of a medical certificate with a de-novo left bundle branch block may be assessed as fit after cardiological evaluation showing no pathology. A period of stability may be required.
(iii) A cardiological evaluation should be required after 12 months in all cases.
(9) Ventricular pre-excitation
Applicants with pre-excitation may be assessed as fit if they are asymptomatic, and an electrophysiological study, including an adequate drug-induced autonomic stimulation protocol, reveals no inducible re-entry tachycardia and the existence of multiple pathways is excluded. Cardiological follow-up should be required including a 24-hour ambulatory ECG recording showing no tendency to symptomatic or asymptomatic tachy-arrhythmia.
(10) Pacemaker
Applicants with a subendocardial pacemaker may be assessed as fit three months after insertion provided:
(i) there is no other disqualifying condition;
(ii) bipolar lead systems programmed in bipolar mode without automatic mode change have been used;
(iii) that the applicant is not pacemaker dependent;
(iv) regular cardiological follow-up should include a symptom-limited exercise ECG that shows no abnormality or evidence of myocardial ischaemia.
(11) QT prolongation
Applicants with asymptomatic QT-prolongation may be assessed as fit subject to a satisfactory cardiological evaluation.
(12) Brugada pattern on electrocardiography
Applicants with a Brugada pattern Type 1 should be assessed as unfit. Applicants with Type 2 or Type 3 may be assessed as fit, with limitations as appropriate, subject to satisfactory cardiological evaluation.
GM1 ATCO.MED.B.010 Cardiovascular system
ED Decision 2015/010/R
MITRAL VALVE DISEASE
(a) Minor regurgitation should have evidence of no thickened leaflets or flail chordae and left atrial internal diameter of less than or equal to 4.0 cm.
(b) The following may indicate severe regurgitation:
(1) LV internal diameter (diastole) > 6.0 cm; or
(2) LV internal diameter (systole) > 4.1 cm; or
(3) Left atrial internal diameter > 4.5 cm.
(c) Doppler indices, such as width of jet, backwards extension and whether there is flow reversal in the pulmonary veins may be helpful in assessing severity of regurgitation.
GM2 ATCO.MED.B.010 Cardiovascular system
ED Decision 2023/011/R
VENTRICULAR PRE-EXCITATION
(a) Asymptomatic applicants with pre-excitation may be assessed as fit at revalidation with an Operational Multi-pilot Limitation (OML) if they meet the following criteria:
(1) no inducible re-entry;
(2) refractory period > 300 ms;
(3) no induced atrial fibrillation.
[applicable until 3 August 2024 - ED Decision 2015/010/R]
(a) Asymptomatic applicants with pre-excitation may be assessed as fit at revalidation if they meet the following criteria:
(1) no inducible re-entry;
(2) refractory period > 300 ms;
(3) no induced atrial fibrillation.
[applicable from 4 August 2024 - ED Decision 2023/011/R]
(b) There should be no evidence of multiple accessory pathways.
GM3 ATCO.MED.B.010 Cardiovascular system
ED Decision 2015/010/R
COMPLETE LEFT BUNDLE BRANCH BLOCK
Left bundle branch block is more commonly associated with coronary artery disease and, thus, requires more in-depth investigation, which may be invasive.
GM4 ATCO.MED.B.010 Cardiovascular system
ED Decision 2015/010/R
PACEMAKER
(a) Scintigraphy may be helpful in the presence of conduction disturbance/paced complexes in the resting ECG.
(b) Experience has shown that any failures of pacemakers are most likely to occur in the first three months after being fitted. Therefore, a fit assessment should not be considered before this period has elapsed.
(c) It is known that certain operational equipment may interfere with the performance of the pacemaker. The type of pacemaker used, therefore, should have been tested to ensure it does not suffer from interference in the operational environment. Supporting data and a performance statement to this effect should be available from the supplier.
GM5 ATCO.MED.B.010 Cardiovascular system
ED Decision 2015/010/R
ANTICOAGULATION
Applicants and licence holders taking anticoagulant medication which requires monitoring with INR testing, should measure their INR on a ‘near patient’ testing system within 12 hours prior to starting a shift pattern and then at least every three days during the shift pattern. The privileges of the licence should only be exercised if the INR is within the target range. The INR result should be recorded and the results should be reviewed at each aero-medical assessment.
ATCO.MED.B.015 Respiratory system
Regulation (EU) 2015/340
(a) Applicants with significant impairment of pulmonary function shall be referred to the licensing authority for the aero-medical assessment. A fit assessment may be considered once pulmonary function has recovered and is satisfactory.
(b) Examination:
Pulmonary function tests are required at the initial examination and on clinical indication.
(c) Applicants with a history or established diagnosis of asthma requiring medication shall undergo a satisfactory respiratory evaluation. A fit assessment may be considered if the applicant is asymptomatic and treatment does not affect safety.
(d) Applicants with a history or established diagnosis in any of the following shall be referred to the licensing authority and undergo respiratory evaluation with a satisfactory result before a fit assessment may be considered:
(1) active inflammatory disease of the respiratory system;
(2) active sarcoidosis;
(3) pneumothorax;
(4) sleep apnoea syndrome;
(5) major thoracic surgery;
(6) chronic obstructive pulmonary disease;
(7) lung transplantation.
AMC1 ATCO.MED.B.015 Respiratory system
ED Decision 2015/010/R
(a) Examination
(1) Spirometric examination is required for initial examination. An FEV1/FVC ratio less than 70 % should require evaluation by a specialist in respiratory disease before a fit assessment can be considered.
(2) Posterior/anterior chest radiography may be required at initial, revalidation or renewal examinations when indicated on clinical or epidemiological grounds.
(b) Chronic obstructive airways disease
Applicants with chronic obstructive airways disease should be assessed as unfit. Applicants with only minor impairment of their pulmonary function may be assessed as fit after specialist respiratory evaluation. Applicants with pulmonary emphysema may be assessed as fit following specialist evaluation showing that the condition is stable and not causing significant symptoms.
(c) Asthma
Applicants with asthma requiring medication or experiencing recurrent attacks of asthma may be assessed as fit if the asthma is considered stable with satisfactory pulmonary function tests and medication is compatible with the safe execution of the privileges of the licence. Use of low dose systemic steroids may be acceptable.
(d) Inflammatory disease
(1) For applicants with active inflammatory disease of the respiratory system, a fit assessment may be considered when the condition has resolved without sequelae and no medication is required.
(2) Applicants with chronic inflammatory diseases may be assessed as fit following specialist evaluation showing mild disease with acceptable pulmonary function test and medication compatible with the safe execution of the privileges of the licence.
(e) Sarcoidosis
(1) Applicants with active sarcoidosis should be assessed as unfit. Specialist evaluation should be undertaken with respect to the possibility of systemic, particularly cardiac, involvement. A fit assessment may be considered if no medication is required, and the disease is limited to hilar lymphadenopathy and inactive. Use of low dose systemic steroids may be acceptable.
(2) Applicants with cardiac or neurological sarcoid should be assessed as unfit.
(f) Pneumothorax
Applicants with a spontaneous pneumothorax should be assessed as unfit. A fit assessment may be considered:
(1) six weeks after the event provided full recovery from a single event has been confirmed in a full respiratory evaluation including a CT scan or equivalent;
(2) following surgical intervention in the case of a recurrent pneumothorax provided there is satisfactory recovery.
(g) Thoracic surgery
(1) Applicants requiring thoracic surgery should be assessed as unfit until such time as the effects of the operation are no longer likely to interfere with the safe exercise of the privileges of the licence.
(2) A fit assessment may be considered after satisfactory recovery and full respiratory evaluation including a CT scan or equivalent. The underlying pathology which necessitated the surgery should be considered in the aero-medical assessment.
(h) Sleep apnoea syndrome/sleep disorder
(1) Applicants with unsatisfactorily treated sleep apnoea syndrome and suffering from excessive daytime sleepiness should be assessed as unfit.
(2) A fit assessment may be considered subject to the extent of symptoms, including vigilance, and satisfactory treatment. ATCO operational experience, sleep apnoea syndrome/sleep disorder education and work place considerations are essential components of the aero-medical assessment.
ATCO.MED.B.020 Digestive system
Regulation (EU) 2015/340
(a) Applicants with any sequelae of disease or surgical intervention in any part of the digestive tract or its adnexa likely to cause incapacitation, in particular any obstruction due to stricture or compression, shall be assessed as unfit.
(b) Applicants shall be free from herniae that might give rise to incapacitating symptoms.
(c) Applicants with disorders of the gastrointestinal system, including those in points (1) to (5) may be assessed as fit subject to a satisfactory gastroenterological evaluation after successful treatment or full recovery after surgery:
(1) recurrent dyspeptic disorder requiring medication;
(2) pancreatitis;
(3) symptomatic gallstones;
(4) an established diagnosis or history of chronic inflammatory bowel disease;
(5) after surgical operation on the digestive tract or its adnexa, including surgery involving total or partial excision or a diversion of any of these organs.
AMC1 ATCO.MED.B.020 Digestive system
ED Decision 2015/010/R
(a) Oesophageal varices
Applicants with oesophageal varices should be assessed as unfit.
(b) Pancreatitis
(1) Applicants with pancreatitis should be assessed as unfit. A fit assessment may be considered if the cause (e.g. gallstone, other obstruction, medication) is removed.
(2) Alcohol may be a cause of dyspepsia and pancreatitis. If considered appropriate, a full evaluation of its use or misuse should be undertaken.
(c) Gallstones
(1) Applicants with a single large gallstone may be assessed as fit after evaluation.
(2) Applicants with multiple gallstones may be assessed as fit while awaiting treatment provided the symptoms are unlikely to interfere with the safe exercise of the privileges of the licence.
(d) Inflammatory bowel disease
Applicants with an established diagnosis or history of chronic inflammatory bowel disease may be assessed as fit if the disease is in established stable remission, and only minimal, if any, medication is being taken. Regular follow-up should be required.
(e) Dyspepsia
Applicants with recurrent dyspepsia requiring medication should be investigated by internal examination including radiologic or endoscopic examination. Laboratory testing should include haemoglobin assessment and faecal examination. Any demonstrated ulceration or significant inflammation requires evidence of recovery before a fit assessment may be considered.
(f) Digestive tract and abdominal surgery
Applicants who have undergone a surgical operation on the digestive tract or its adnexa, including a total or partial excision or a diversion of any of these organs, should be assessed as unfit. A fit assessment may be considered if recovery is complete, the applicant is asymptomatic and the risk of secondary complication or recurrence is minimal.
ATCO.MED.B.025 Metabolic and endocrine systems
Regulation (EU) 2015/340
(a) Applicants with metabolic, nutritional or endocrine dysfunction may be assessed as fit subject to demonstrated stability of the condition and satisfactory aero-medical evaluation.
(b) Diabetes mellitus:
(1) Applicants with diabetes mellitus requiring insulin shall be assessed as unfit.
(2) Applicants with diabetes mellitus requiring medication other than insulin for blood sugar control shall be referred to the licensing authority. A fit assessment may be considered if it can be demonstrated that blood sugar control has been achieved and is stable.
AMC1 ATCO.MED.B.025 Metabolic and endocrine system
ED Decision 2015/010/R
(a) Metabolic, nutritional or endocrine dysfunction
Applicants with metabolic, nutritional or endocrine dysfunction may be assessed as fit if the condition is asymptomatic, clinically compensated and stable with or without replacement therapy, and regularly reviewed by an appropriate specialist.
(b) Obesity
(1) Applicants with a Body Mass Index 35 may be assessed as fit only if the excess weight is not likely to interfere with the safe exercise of the privileges of the licence and a satisfactory cardiovascular risk review and evaluation of the possibility of sleep apnoea syndrome has been undertaken.
(2) Functional testing in the working environment may be necessary before a fit assessment may be considered.
(c) Thyroid dysfunction
Applicants with hyperthyroidism or hypothyroidism should attain a stable euthyroid state before a fit assessment may be considered.
(d) Abnormal glucose metabolism
Glycosuria and abnormal blood glucose levels require investigation. A fit assessment may be considered if normal glucose tolerance is demonstrated (low renal threshold) or impaired glucose tolerance without diabetic pathology is fully controlled by diet and regularly reviewed.
(e) Diabetes mellitus
(1) The following medication, alone and in combination, may be acceptable for control of type 2 diabetes:
(i) alpha-glucosidase inhibitors;
(ii) medication that acts on the incretin pathway;
(iii) biguanides.
(2) A fit assessment may be considered after evaluation of the operational environment, including means of glucose monitoring/management whilst performing rated duties, and with demonstrated exemplary glycaemic control.
(3) Annual follow-up by a specialist should be required including demonstration of absence of complications, good glycaemic control demonstrated by six-monthly HbA1c measurements, and a normal exercise tolerance test.
Regulation (EU) 2015/340
(a) Blood testing, if any, shall be determined by the AME or AeMC taking into account the medical history and following the physical examination.
(b) Applicants with a haematological condition, such as:
(1) coagulation, haemorrhagic or thrombotic disorder;
(2) chronic leukaemia;
(3) abnormal haemoglobin, including, but not limited to, anaemia, erythrocytosis or haemoglobinopathy;
(4) significant lymphatic enlargement;
(5) enlargement of the spleen;
shall be referred to the licensing authority. A fit assessment may be considered subject to satisfactory aero-medical evaluation.
(c) Applicants suffering from acute leukaemia shall be assessed as unfit.
AMC1 ATCO.MED.B.030 Haematology
ED Decision 2015/010/R
(a) Anaemia
(1) Anaemia demonstrated by a reduced haemoglobin level should require investigation. A fit assessment may be considered in cases where the primary cause has been treated (e.g. iron or B12 deficiency) and the haemoglobin or haematocrit has stabilised at a satisfactory level. The recommended range of the haemoglobin level is 11–17 g/dl.
(2) Anaemia which is unamenable to treatment should be disqualifying.
(b) Haemoglobinopathy
Applicants with a haemoglobinopathy should be assessed as unfit. A fit assessment may be considered where minor thalassaemia, sickle cell disease or other haemoglobinopathy is diagnosed without a history of crises and where full functional capability is demonstrated.
(c) Coagulation disorders
(1) Significant coagulation disorders require investigation. A fit assessment may be considered if there is no history of significant bleeding or clotting episodes and the haematological data indicate that it is safe to do so.
(2) If anticoagulant therapy is prescribed, AMC1 ATCO.MED.B.010(g) should be followed.
(d) Disorders of the lymphatic system
Lymphatic enlargement requires investigation. A fit assessment may be considered in cases of an acute infectious process which is fully recovered, or Hodgkin’s lymphoma, or other lymphoid malignancy which has been treated and is in full remission, or that requires minimal or no treatment.
(e) Leukaemia
(1) Applicants with acute leukaemia should be assessed as unfit. Once in established remission, applicants may be assessed as fit.
(2) Applicants with chronic leukaemia should be assessed as unfit. A fit assessment may be considered after remission and a period of demonstrated stability.
(3) Applicants with a history of leukaemia should have no history of central nervous system involvement and no continuing side effects from treatment which are likely to interfere with the safe exercise of the privileges of the licence. Haemoglobin and platelet levels should be satisfactory.
(4) Regular follow-up is required in all cases of leukaemia.
(f) Splenomegaly
Splenomegaly requires investigation. A fit assessment may be considered if the enlargement is minimal, stable and no associated pathology is demonstrated, or if the enlargement is minimal and associated with another acceptable condition.
GM1 ATCO.MED.B.030 Haematology
ED Decision 2015/010/R
HODGKIN’S LYMPHOMA
Due to potential side effects of specific chemotherapeutic agents, the precise regime utilised should be taken into account.
GM2 ATCO.MED.B.030 Haematology
ED Decision 2015/010/R
CHRONIC LEUKAEMIA
A fit assessment may be considered if the chronic leukaemia has been diagnosed as:
(a) lymphatic at stages 0, I, and possibly II without anaemia and minimal treatment; or
(b) stable ‘hairy cell’ leukaemia with normal haemoglobin and platelets.
GM3 ATCO.MED.B.030 Haematology
ED Decision 2015/010/R
SPLENOMEGALY
(a) Splenomegaly should not preclude a fit assessment, but should be assessed on an individual basis.
(b) Associated pathology of splenomegaly is e.g. treated chronic malaria.
(c) An acceptable condition associated with splenomegaly is e.g. Hodgkin’s lymphoma in remission.
ATCO.MED.B.035 Genitourinary system
Regulation (EU) 2015/340
(a) Urinalysis shall form part of every aero-medical examination. The urine shall contain no abnormal element considered to be of pathological significance.
(b) Applicants with any sequelae of disease or surgical procedures on the genitourinary system or its adnexa likely to cause incapacitation, in particular any obstruction due to stricture or compression, shall be assessed as unfit.
(c) Applicants with a genitourinary disorder, such as:
(1) renal disease;
(2) one or more urinary calculi;
may be assessed as fit subject to satisfactory renal/urological evaluation.
(d) Applicants who have undergone:
(1) a major surgical operation in the genitourinary system or its adnexa involving a total or partial excision or a diversion of its organs; or
(2) major urological surgery;
shall be referred to the licensing authority for an aero-medical assessment after full recovery before a fit assessment may be considered.
AMC1 ATCO.MED.B.035 Genitourinary system
ED Decision 2015/010/R
(a) Abnormal urinalysis
Any abnormal finding on urinalysis requires investigation. This investigation should include proteinuria, haematuria and glycosuria.
(b) Renal disease
(1) Applicants presenting with any signs of renal disease should be assessed as unfit. A fit assessment may be considered if blood pressure is satisfactory and renal function is acceptable.
(2) Applicants requiring dialysis should be assessed as unfit.
(c) Urinary calculi
(1) Applicants with an asymptomatic calculus or a history of renal colic require investigation. A fit assessment may be considered after successful treatment for a calculus and with appropriate follow-up.
(2) Residual calculi should be disqualifying unless they are in a location where they are unlikely to move and give rise to symptoms.
(d) Renal and urological surgery
(1) Applicants who have undergone a major surgical operation on the genitourinary system or its adnexa involving a total or partial excision or a diversion of any of its organs should be assessed as unfit until recovery is complete, the applicant is asymptomatic and the risk of secondary complications is minimal.
(2) Applicants with compensated nephrectomy without hypertension or uraemia may be assessed as fit.
(3) Applicants who have undergone renal transplantation may be considered for a fit assessment if it is fully compensated and tolerated with only minimal immuno-suppressive therapy after at least 12 months.
(4) Applicants who have undergone total cystectomy may be considered for a fit assessment if there is satisfactory urinary function, no infection and no recurrence of primary pathology.
ATCO.MED.B.040 Infectious disease
Regulation (EU) 2015/340
(a) Applicants who are HIV positive shall be referred to the licensing authority and may be assessed as fit subject to satisfactory specialist evaluation and provided the licensing authority has sufficient evidence that the therapy does not compromise the safe exercise of the privileges of the licence.
(b) Applicants diagnosed with or presenting symptoms of infectious disease such as:
(1) acute syphilis;
(2) active tuberculosis;
(3) infectious hepatitis;
(4) tropical diseases;
shall be referred to the licensing authority for an aero-medical assessment. A fit assessment may be considered after full recovery and specialist evaluation provided the licensing authority has sufficient evidence that the therapy does not compromise the safe exercise of the privileges of the licence.
AMC1 ATCO.MED.B.040 Infectious disease
ED Decision 2015/010/R
(a) Infectious disease — General
In cases of infectious disease, consideration should be given to a history of, or clinical signs indicating, underlying impairment of the immune system.
(b) Tuberculosis
(1) Applicants with active tuberculosis should be assessed as unfit. A fit assessment may be considered following completion of therapy.
(2) Applicants with quiescent or healed lesions may be assessed as fit. Specialist evaluation should consider the extent of the disease, the treatment required and possible side effects of medication.
(c) Syphilis
Applicants with acute syphilis should be assessed as unfit. A fit assessment may be considered in the case of those fully treated and recovered from the primary and secondary stages.
(d) HIV positivity
(1) Applicants who are HIV positive may be assessed as fit if a full investigation provides no evidence of HIV associated diseases that might give rise to incapacitating symptoms. Frequent review of the immunological status and neurological evaluation by an appropriate specialist should be carried out. A cardiological review may also be required depending on medication.
(2) Applicants with an AIDS defining condition should be assessed as unfit except in individual cases for revalidation of a medical certificate after complete recovery and dependent on the review.
(3) The aero-medical assessment of individual cases under (1) and (2) should be dependent on the absence of symptoms or signs of the disease and the acceptability of serological markers. Treatment should be evaluated by a specialist on an individual basis for its appropriateness and any side effects.
(e) Infectious hepatitis
Applicants with infectious hepatitis should be assessed as unfit. A fit assessment may be considered once the applicant has become asymptomatic after treatment and specialist evaluation. Regular review of the liver function should be carried out.
GM1 ATCO.MED.B.040 Infectious disease
ED Decision 2015/010/R
HIV INFECTION
(a) There is no requirement for routine testing of HIV status, but testing may be carried out on clinical indication.
(b) If HIV positivity has been confirmed, a process of rigorous aero-medical assessment and follow-up should be introduced to enable individuals to continue working provided their ability to exercise their licenced privileges to the required level of safety is not impaired. The operational environment should be considered in the decision-making.
ATCO.MED.B.045 Obstetrics and gynaecology
Regulation (EU) 2015/340
(a) Applicants who have undergone a major gynaecological operation shall be assessed as unfit until full recovery.
(b) Pregnancy:
In the case of pregnancy, if the AeMC or AME considers that the licence holder is fit to exercise her privileges, he/she shall limit the validity period of the medical certificate to the end of the 34th week of gestation. The licence holder shall undergo a revalidation aero-medical examination and assessment after full recovery following the end of the pregnancy.
AMC1 ATCO.MED.B.045 Obstetrics and gynaecology
ED Decision 2015/010/R
(a) Gynaecological surgery
Applicants who have undergone a major gynaecological operation should be assessed as unfit until recovery is complete, the applicant is asymptomatic and the risk of secondary complications or recurrence is minimal.
(b) Pregnancy
(1) A pregnant licence holder may be assessed as fit during the first 34 weeks of gestation provided obstetric evaluation continuously indicates a normal pregnancy.
(2) The AeMC or AME or the licensing authority should provide written advice to the applicant and the supervising physician regarding potentially significant complications of pregnancy which may negatively influence the safe exercise of the privileges of the licence.
ATCO.MED.B.050 Musculoskeletal system
Regulation (EU) 2015/340
(a) Applicants shall have satisfactory functional use of the musculoskeletal system to enable them to safely exercise the privileges of the licence.
(b) Applicants with static or progressive musculoskeletal or rheumatologic conditions likely to interfere with the safe exercise of the licence privileges shall be referred to the licensing authority. A fit assessment may be considered after satisfactory specialist evaluation.
AMC1 ATCO.MED.B.050 Musculoskeletal system
ED Decision 2015/010/R
(a) Applicants with any significant sequelae from disease, injury or congenital abnormality affecting the bones, joints, muscles or tendons with or without surgery require full evaluation prior to a fit assessment.
(b) Abnormal physique, including obesity, or muscular weakness may require aero-medical assessment and particular attention should be paid to an aero-medical assessment in the working environment.
(c) Locomotor dysfunction, amputations, malformations, loss of function and progressive osteoarthritic disorders should be assessed on an individual basis in conjunction with the appropriate operational expert with a knowledge of the complexity of the tasks of the applicant.
(d) Applicants with inflammatory, infiltrative or degenerative disease of the musculoskeletal system may be assessed as fit provided the condition is in remission and the medication is acceptable.
Regulation (EU) 2015/340
(a) Applicants with a mental or behavioural disorder due to alcohol or other use or misuse of psychoactive substances, including recreational substances with or without dependency, shall be assessed as unfit until after a period of documented sobriety or freedom from psychoactive substance use or misuse and subject to satisfactory psychiatric evaluation after successful treatment. Applicants shall be referred to the licensing authority.
(b) Applicants with a psychiatric condition such as:
(1) mood disorder;
(2) neurotic disorder;
(3) personality disorder;
(4) mental or behavioural disorder;
shall undergo satisfactory psychiatric evaluation before a fit assessment may be considered. Applicants shall be referred to the licensing authority for the assessment of their medical fitness.
(c) Applicants with a history of a single or repeated acts of deliberate self-harm shall be assessed as unfit. Applicants shall be referred to the licensing authority and shall undergo satisfactory psychiatric evaluation before a fit assessment may be considered.
(d) Applicants with an established history or clinical diagnosis of schizophrenia, schizotypal, delusional disorder or mania shall be assessed as unfit.
AMC1 ATCO.MED.B.055 Psychiatry
ED Decision 2015/010/R
(a) Disorders due to alcohol or other substance use
(1) A fit assessment may be considered after successful treatment, a period of documented sobriety or freedom from substance use, and review by a psychiatric specialist. The licensing authority, with the advice of the psychiatric specialist, should determine the duration of the period to be observed before a medical certificate can be issued.
(2) Depending on the individual case, treatment may include in-patient treatment of some weeks.
(3) Continuous follow-up, including blood testing and peer reports, may be required indefinitely.
(b) Mood disorder
Applicants with an established mood disorder should be assessed as unfit. After full recovery and after full consideration of an individual case, a fit assessment may be considered depending on the characteristics and gravity of the mood disorder. If stability on maintenance psychotropic medication is confirmed, a fit assessment with an appropriate limitation may be considered. If the dosage of the medication is changed, a further period of unfit assessment should be required. Regular specialist supervision should be required.
(c) Psychotic disorder
Applicants with a history, or the occurrence, of a functional psychotic disorder should be assessed as unfit. A fit assessment may be considered if a cause can be unequivocally identified as one which is transient, has ceased and the risk of recurrence is minimal.
(d) Deliberate self-harm
Applicants who have carried out a single self-destructive action or repeated acts of deliberate self-harm should be assessed as unfit. A fit assessment may be considered after full consideration of an individual case which may require psychiatric or psychological evaluation. Neuropsychological evaluation may also be required.
Regulation (EU) 2015/340
(a) Applicants who present with stress-related symptoms that are likely to interfere with their ability to exercise the privileges of the licence safely shall be referred to the licensing authority. A fit assessment may only be considered after a psychological and/or psychiatric evaluation has demonstrated that the applicant has recovered from stress-related symptoms.
(b) A psychological evaluation may be required as part of, or complementary to, a specialist psychiatric or neurological examination.
AMC1 ATCO.MED.B.060 Psychology
ED Decision 2015/010/R
(a) If a psychological evaluation is indicated, it should be carried out by a psychologist taking into account the ATC environment and the associated risks.
(b) Where there is established evidence that an applicant may have a psychological disorder, the applicant should be referred for psychological opinion and advice.
(c) Established evidence should be verifiable information from an identifiable source related to the mental fitness or personality of a particular individual. Sources for this information can be accidents or incidents, problems in training or competence assessments, behaviour or knowledge relevant to the safe exercise of the privileges of the licence.
(d) The psychological evaluation may include a collection of biographical data, the administration of aptitude, as well as personality tests and psychological interview.
(e) The psychologist should submit a written report to the AME, AeMC or licensing authority as appropriate, detailing his/her opinion and recommendation.
Regulation (EU) 2015/340
(a) Applicants with an established history or clinical diagnosis of the following shall be assessed as unfit:
(1) epilepsy except in cases in point (b)(1) and (2);
(2) recurring episodes of disturbance of consciousness of uncertain cause;
(3) conditions with a high propensity for cerebral dysfunction.
(b) Applicants with an established history or clinical diagnosis of the following conditions shall be referred to the licensing authority and undergo further evaluation before a fit assessment may be considered:
(1) epilepsy without recurrence after the age of 5;
(2) epilepsy without recurrence and off all treatment for more than 10 years;
(3) epileptiform EEG abnormalities and focal slow waves;
(4) progressive or non-progressive disease of the nervous system;
(5) a single episode of disturbances or loss of consciousness;
(6) brain injury;
(7) spinal or peripheral nerve injury;
(8) disorders of the nervous system due to vascular deficiencies including haemorrhagic and ischaemic events.
ED Decision 2015/010/R
(a) Electroencephalography (EEG)
(1) EEG should be carried out when indicated by the applicant’s history or on clinical grounds.
(2) Epileptiform paroxysmal EEG abnormalities and focal slow waves should be disqualifying. A fit assessment may be considered after further evaluation.
(b) Epilepsy
(1) Applicants who have experienced one or more convulsive episodes after the age of five should be assessed as unfit.
(2) A fit assessment may be considered if:
(i) the applicant is seizure free and off medication for a period of at least 10 years;
(ii) full neurological evaluation shows that a seizure was caused by a specific non-recurrent cause, such as trauma or toxin.
(3) Applicants who have experienced an episode of benign Rolandic seizure may be assessed as fit provided the seizure has been clearly diagnosed including a properly documented history and typical EEG result and the applicant has been free of symptoms and off treatment for at least 10 years.
(c) Neurological disease
Applicants with any stationary or progressive disease of the nervous system which has caused or is likely to cause a significant disability should be assessed as unfit. A fit assessment may be considered after full neurological evaluation in cases of minor functional losses associated with stationary disease.
(d) Disturbance of consciousness
Applicants with a history of one or more episodes of disturbed consciousness may be assessed as fit if the condition can be satisfactorily explained by a non-recurrent cause. A full neurological evaluation is required.
(e) Head injury
Applicants with a head injury which was severe enough to cause loss of consciousness or is associated with penetrating brain injury should be evaluated by a consultant neurologist. A fit assessment may be considered if there has been a full recovery and the risk of epilepsy is sufficiently low. Behavioural and cognitive aspects should be taken into account.
Regulation (EU) 2015/340
(a) Examination:
(1) A comprehensive eye examination shall form part of the initial examination and be undertaken periodically depending on the refraction and the functional performance of the eye.
(2) A routine eye examination shall form part of all revalidation and renewal examinations.
(3) Applicants shall undergo tonometry at the first revalidation examination after the age of 40, on clinical indication and if indicated considering the family history.
(4) Applicants shall supply the AeMC or AME with an ophthalmic examination report in cases where:
(i) the functional performance shows significant changes;
(ii) the distant visual standards can only be reached with corrective lenses.
(5) Applicants with a high refractive error shall be referred to the licensing authority.
(b) Distant visual acuity, with or without optimal correction, shall be 6/9 (0,7) or better in each eye separately, and visual acuity with both eyes shall be 6/6 (1,0) or better.
(c) Initial applicants having monocular or functional monocular vision, including eye muscle balance problems, shall be assessed as unfit. At revalidation or renewal examinations the applicant may be assessed as fit provided that an ophthalmological examination is satisfactory. The applicant shall be referred to the licensing authority.
(d) Initial applicants with acquired substandard vision in one eye shall be assessed as unfit. At revalidation or renewal examinations the applicant shall be referred to the licensing authority and may be assessed as fit provided that an ophthalmological examination is satisfactory.
(e) Applicants shall be able to read an N5 chart or equivalent at 30 – 50 cm and an N14 chart or equivalent at 60 – 100 cm distance, if necessary with the aid of correction.
(f) Applicants shall have normal fields of vision and normal binocular function.
(g) Applicants who have undergone eye surgery shall be assessed as unfit until full recovery of the visual function. A fit assessment may be considered by the licensing authority subject to satisfactory ophthalmic evaluation.
(h) Applicants with a clinical diagnosis of keratoconus shall be referred to the licensing authority and may be assessed as fit subject to a satisfactory examination by an ophthalmologist.
(i) Applicants with diplopia shall be assessed as unfit.
(j) Spectacles and contact lenses
(1) If satisfactory visual function for the rated duties is achieved only with the use of correction, the spectacles or contact lenses must provide optimal visual function, be well tolerated, and suitable for air traffic control purposes.
(2) No more than one pair of spectacles, when worn during the exercise of licensed privileges, shall be used to meet the visual requirements at all distances.
(3) A spare set of similarly correcting spectacles shall be readily available when exercising the privileges of the licence(s).
(4) Contact lenses, when are worn during the exercise of licensed privileges, shall be mono-focal, non-tinted and not orthokeratological. Monovision contact lenses shall not be used.
(5) Applicants with a large refractive error shall use contact lenses or high index spectacle lenses.
AMC1 ATCO.MED.B.070 Visual system
ED Decision 2015/010/R
(a) Eye examination
(1) At each aero-medical revalidation examination, the visual fitness should be assessed and the eyes should be examined with regard to possible pathology.
(2) All abnormal and doubtful cases should be referred to an ophthalmologist. Conditions which indicate ophthalmological examination include but are not limited to a substantial decrease in the uncorrected visual acuity, any decrease in best corrected visual acuity and/or the occurrence of eye disease, eye injury or eye surgery.
(3) Where ophthalmological examinations are required for any significant reason, this should be imposed as a limitation on the medical certificate.
(4) The effect of multiple eye conditions should be evaluated by an ophthalmologist with regard to possible cumulative effects. Functional testing in the working environment may be necessary to consider a fit assessment.
(5) Visual acuity should be tested using Snellen charts, or equivalent, under appropriate illumination. Where clinical evidence suggests that Snellen may not be appropriate, Landolt ‘C’ may be used.
(b) Comprehensive eye examination
A comprehensive eye examination by an eye specialist is required at the initial examination. All abnormal and doubtful cases should be referred to an ophthalmologist. The examination should include:
(1) history;
(2) visual acuities — near, intermediate and distant vision; uncorrected and with best optical correction if needed;
(3) objective refraction — hyperopic initial applicants with a hyperopia of more than +2 dioptres and under the age of 25 in cycloplegia;
(4) ocular motility and binocular vision;
(5) colour vision;
(6) visual fields;
(7) tonometry;
(8) examination of the external eye, anatomy, media (slit lamp) and fundoscopy;
(9) assessment of contrast and glare sensitivity.
(c) Routine eye examination
At each revalidation or renewal examination, the visual fitness should be assessed and the eyes should be examined with regard to possible pathology. All abnormal and doubtful cases should be referred to an ophthalmologist. This routine eye examination should include:
(1) history;
(2) visual acuities — near, intermediate and distant vision; uncorrected and with best optical correction if needed;
(3) morphology by ophthalmoscopy;
(4) further examination on clinical indication.
(d) Refractive error
(1) Applicants with a refractive error between +5.0/-6.0 dioptres may be assessed as fit provided optimal correction has been considered and no significant pathology is demonstrated. If the refractive error exceeds +3.0/-3.0 dioptres, a four-yearly follow-up by an eye specialist should be required.
(2) Applicants with:
(i) a refractive error exceeding -6 dioptres;
(ii) an astigmatic component exceeding 3 dioptres; or
(iii) anisometropia exceeding 3 dioptres;
may be considered for a fit assessment if:
(A) no significant pathology can be demonstrated;
(B) optimal correction has been considered;
(C) visual acuity is at least 6/6 (1.0) in each eye separately with normal visual fields while wearing the optimal spectacle correction;
(D) two-yearly follow-up is undertaken by an eye specialist.
(3) Applicants with hypermetropia exceeding +5.0 dioptres may be assessed as fit subject to a satisfactory ophthalmological evaluation provided there are adequate fusional reserves, normal intraocular pressures and anterior angles and no significant pathology has been demonstrated. Corrected visual acuity in each eye shall be 6/6 or better.
(4) Applicants with a large refractive error shall use contact lenses or high-index spectacle lenses.
(e) Convergence
Applicants with convergence outside the normal range may be assessed as fit provided it does not interfere with near vision (30–50 cm) or intermediate vision (100 cm) with or without correction.
(f) Substandard vision
(1) Applicants with reduced central vision in one eye may be assessed as fit for a revalidation or renewal of a medical certificate if the binocular visual field is normal and the underlying pathology is acceptable according to ophthalmological evaluation. Testing should include functional testing in the appropriate working environment.
(2) Applicants with acquired substandard vision in one eye (monocularity, functional monocular vision including eye muscle imbalance) may be assessed as fit for revalidation or renewal if the ophthalmological examination confirms that:
(i) the better eye achieves distant visual acuity of 1.0 (6/6), corrected or uncorrected;
(ii) the better eye achieves intermediate and near visual acuity of 0.7 (6/9), corrected or uncorrected;
(iii) there is no significant ocular pathology;
(iv) a functional test in the working environment is satisfactory; and
(v) in the case of acute loss of vision in one eye, a period of adaptation time has passed from the known point of visual loss, during which the applicant is assessed as unfit.
(3) An applicant with a monocular visual field defect may be assessed as fit if the binocular visual fields are normal.
(g) Keratoconus
Applicants with keratoconus may be considered for a fit assessment if the visual requirements are met with the use of corrective lenses and periodic review is undertaken by an ophthalmologist.
(h) Heterophoria
Applicants with heterophoria (imbalance of the ocular muscles) exceeding when measured with optimal correction, if prescribed:
(1) at six metres:
— 2.0 prism dioptres in hyperphoria,
— 10.0 prism dioptres in esophoria,
— 8.0 prism dioptres in exophoria
— and
(2) at 33 centimetres:
— 1.0 prism dioptre in hyperphoria,
— 8.0 prism dioptres in esophoria,
— 12.0 prism dioptres in exophoria
may be assessed as fit provided that orthoptic evaluation demonstrates that the fusional reserves are sufficient to prevent asthenopia and diplopia. The Netherlands Optical Society (TNO) testing or equivalent should be carried out to demonstrate fusion.
(i) Eye surgery
(1) After refractive surgery or surgery of the cornea including cross linking, a fit assessment may be considered, provided:
(i) satisfactory stability of refraction has been achieved (less than 0.75 dioptres variation diurnally);
(ii) examination of the eye shows no post-operative complications;
(iii) glare sensitivity is normal;
(iv) mesopic contrast sensitivity is not impaired;
(v) evaluation is undertaken by an ophthalmologist.
(2) Cataract surgery
Following intraocular lens surgery, including cataract surgery, a fit assessment may be considered once recovery is complete and the visual requirements are met with or without correction. Intraocular lenses should be monofocal and should not impair colour vision.
(3) Retinal surgery/retinal laser therapy
(i) After successful retinal surgery, applicants may be assessed as fit once the recovery is complete. Annual ophthalmological follow-up may be necessary. Longer periods may be acceptable after two years on recommendation of the ophthalmologist.
(ii) After successful retinal laser therapy, applicants may be assessed as fit provided an ophthalmological evaluation shows stability.
(4) Glaucoma surgery
A fit assessment may be considered six months after successful glaucoma surgery, or earlier if recovery is complete. Six-monthly ophthalmological examinations to follow up secondary complications caused by the glaucoma may be necessary.
(5) Extraocular muscle surgery
A fit assessment may be considered not less than six months after surgery and after a satisfactory ophthalmological evaluation.
(j) Visual correction
Spectacles should permit the licence holder to meet the visual requirements at all distances.
GM1 ATCO.MED.B.070 Visual system
ED Decision 2015/010/R
COMPARISON OF DIFFERENT READING CHARTS (APPROXIMATE FIGURES)
(a) Test distance: 40 cm
|
Decimal |
Nieden |
Jäger |
Snellen |
N |
Parinaud |
|
1,0 |
1 |
2 |
1,5 |
3 |
2 |
|
0,8 |
2 |
3 |
2 |
4 |
3 |
|
0,7 |
3 |
4 |
2,5 |
|
|
|
0,6 |
4 |
5 |
3 |
5 |
4 |
|
0,5 |
5 |
5 |
|
6 |
5 |
|
0,4 |
7 |
9 |
4 |
8 |
6 |
|
0,35 |
8 |
10 |
4,5 |
|
8 |
|
0,32 |
9 |
12 |
5,5 |
10 |
10 |
|
0,3 |
9 |
12 |
|
12 |
|
|
0,25 |
9 |
12 |
|
14 |
|
|
0,2 |
10 |
14 |
7,5 |
16 |
14 |
|
0,16 |
11 |
14 |
12 |
20 |
|
(b) Test distance: 80 cm
|
Decimal |
Nieden |
Jäger |
Snellen |
N |
Parinaud |
|
1,2 |
4 |
5 |
3 |
5 |
4 |
|
1,0 |
5 |
5 |
|
6 |
5 |
|
0,8 |
7 |
9 |
4 |
8.0 |
6 |
|
0,7 |
8 |
10 |
4,5 |
|
8 |
|
0,63 |
9 |
12 |
5,5 |
10 |
10 |
|
0,6 |
9 |
12 |
|
12 |
10 |
|
0,5 |
9 |
12 |
|
14 |
10 |
|
0,4 |
10 |
14 |
7,5 |
16 |
14 |
|
0,32 |
11 |
14 |
12 |
20 |
14 |
AMC1 ATCO.MED.B.075 Colour vision
ED Decision 2015/010/R
(a) Pseudoisochromatic plate testing alone is not sufficient.
(b) Colour vision should be assessed using means to demonstrate normal trichromacy.
GM1 ATCO.MED.B.075 Colour vision
ED Decision 2015/010/R
The means to demonstrate normal trichromacy include:
(a) anomaloscopy (Nagel or equivalent). This test is considered passed if the colour match is trichromatic and the matching range is four scale units or less;
(b) Colour Assessment and Diagnosis (CAD) test.
ATCO.MED.B.080 Otorhinolaryngology
Regulation (EU) 2015/340
(a) Examination:
(1) A routine otorhinolaryngological examination shall form part of all initial, revalidation and renewal examinations.
(2) Hearing shall be tested at all examinations. The applicant shall understand correctly conversational speech when tested with each ear at a distance of 2 metres from and with his/her back turned towards the AME.
(3) Hearing shall be tested with pure tone audiometry at the initial examination and at subsequent revalidation or renewal examinations every 4 years until the age of 40 and every 2 years thereafter.
(4) Pure-tone audiometry:
(i) Applicants for a class 3 medical certificate shall not have a hearing loss of more than 35 dB at any of the frequencies 500, 1000 or 2000 Hz, or more than 50 dB at 3000 Hz, in either ear separately.
(ii) Applicants who do not meet the hearing criteria above shall be referred to the licensing authority and undergo a specialist assessment before a fit assessment may be considered. Initial applicants shall undergo a speech discrimination test. Applicants for a revalidation or renewal of a class 3 medical certificate shall undergo a functional hearing test in the operational environment.
(5) Hearing aids:
(i) Initial examination: the need of hearing aids to comply with the hearing requirements entails unfitness.
(ii) Revalidation and renewal examinations: a fit assessment may be considered if the use of hearing aid(s) or of an appropriate prosthetic aid improves the hearing to achieve a normal standard as assessed by fully functional testing in the operational environment.
(iii) If a prosthetic aid is needed to achieve the normal hearing standard, a spare set of the equipment and accessories, such as batteries, shall be available when exercising the privileges of the licence.
(b) Applicants with:
(1) an active chronic pathological process of the internal or middle ear;
(2) unhealed perforation or dysfunction of the tympanic membrane(s);
(3) disturbance of vestibular function;
(4) significant malformation or significant chronic infection of the oral cavity or upper respiratory tract;
(5) significant disorder of speech or voice reducing intelligibility;
shall be referred to the licensing authority and undergo further ORL examination and assessment to establish that the condition does not interfere with the safe exercise of the privileges of the licence.
AMC1 ATCO.MED.B.080 Otorhinolaryngology
ED Decision 2015/010/R
(a) Examination
(1) An otorhinolaryngological examination includes:
(i) history;
(ii) clinical examination including otoscopy, rhinoscopy and examination of the mouth and throat;
(iii) clinical examination of the vestibular system.
(2) Ear, nose and throat (ENT) specialists involved in the aero-medical assessment of air traffic controllers should have an understanding of the functionality required by air traffic controllers whilst exercising the privileges of their licence(s).
(3) Where a full aero-medical assessment and functional check are needed, due regard should be paid to the operational environment in which the operational functions are undertaken.
(b) Hearing
(1) The follow-up of an applicant with hypoacusis should be decided by the licensing authority. If at the next annual test there is no indication of further deterioration, the normal frequency of testing may be resumed.
(2) An appropriate prosthetic aid may be a special headset with individual earpiece volume controls. Full functional and environmental assessments should be carried out with the chosen prosthetic equipment in use.
(c) Ear conditions
An applicant with a single dry perforation of non-infectious origin and which does not interfere with the normal function of the ear may be considered for a fit assessment.
(d) Vestibular disturbance
The presence of vestibular disturbance and spontaneous or positional nystagmus requires complete vestibular evaluation by a specialist. Significant abnormal caloric or rotational vestibular responses are disqualifying. At revalidation and renewal aero-medical examinations, abnormal vestibular responses should be assessed in their clinical context.
(e) Speech disorder
Applicants with a speech disorder should be assessed with due regard to the operational environment in which the operational functions are undertaken. Applicants with significant disorder of speech or voice should be assessed as unfit.
GM1 ATCO.MED.B.080 Otorhinolaryngology
ED Decision 2015/010/R
HEARING
(a) Speech discrimination test: discriminating speech against other noise including other sources of verbal communication and ambient noise in the working environment, but not against engine noise.
(b) Functional hearing test: the objective of this test is to evaluate the controller’s ability to hear the full range of communications that occur in an operational environment and not just through a headset or speaker.
(c) Prosthetic aid: the functional hearing test to be carried out with the prosthetic aid in use is to ensure that the individual is able to perform the functions of his/her licence and that the equipment is not adversely affected by interference from headsets or other factors.
(d) Pure-tone audiometry: testing at frequencies at or above 4 000 Hz will aid the early diagnosis of acoustic neuroma, noise-induced hearing loss (NIH) and other disorders of hearing. Particular attention should be paid in cases where there is a significant difference between thresholds of the left and right ear.
Regulation (EU) 2015/340
Applicants shall have no established dermatological condition likely to interfere with the safe exercise of the privileges of the licence held.
AMC1 ATCO.MED.B.085 Dermatology
ED Decision 2015/010/R
(a) Referral to the licensing authority should be made if doubt exists about the fitness of an applicant with eczema (exogenous and endogenous), severe psoriasis, chronic infections, drug-induced or bullous eruptions or urticaria.
(b) Systemic effects of radiation or pharmacological treatment for a dermatological condition should be evaluated before a fit assessment may be considered.
(c) An applicant with a skin condition that causes pain, discomfort, irritation or itching may only be assessed as fit if the condition can be controlled and does not interfere with the safe exercise of the privileges of the licence.
(d) In cases where a dermatological condition is associated with a systemic illness, full consideration should be given to the underlying illness before a fit assessment may be considered.
Regulation (EU) 2015/340
(a) After diagnosis of primary or secondary malignant disease, applicants shall be referred to the licensing authority and shall undergo satisfactory oncological evaluation before a fit assessment may be considered.
(b) Applicants with an established history or clinical diagnosis of an intracerebral malignant tumour shall be assessed as unfit.
ED Decision 2015/010/R
(a) Applicants who have been diagnosed with a malignant disease may be assessed as fit provided:
(1) after primary treatment there is no evidence of residual malignant disease likely to interfere with the safe exercise of the privileges of the licence;
(2) time appropriate to the type of tumour has elapsed since the end of primary treatment;
(3) the risk of incapacitation from a recurrence or metastasis is sufficiently low;
(4) there is no evidence of short- or long-term sequelae from treatment. Special attention should be paid to applicants who have received anthracycline chemotherapy;
(5) satisfactory oncology follow-up reports are provided to the licensing authority.
(b) Applicants receiving ongoing chemotherapy or radiation treatment should be assessed as unfit.
(c) Applicants with a benign intracerebral tumour may be assessed as fit after satisfactory specialist and neurological evaluation and the condition does not compromise the safe exercise of the privileges of the licence.
(d) Applicants with pre-malignant conditions may be assessed as fit if treated or excised as necessary and there is a regular follow-up.