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Disposal - Medical / Surgical

  • An applicant for any class of Medical Assessment shall be required to be free from:

    • a) any abnormality, congenital or acquired; or

    • b) any active, latent, acute or chronic disability; or

    • c) any wound, injury or sequelae from operation; or

    • d) any effect or side-effect of any prescribed or non-prescribed therapeutic, diagnostic or preventive medication taken;

such as would entail a degree of functional incapacity which is likely to interfere with the safe operation of an aircraft or with the safe performance of duties.

The Important Medical Disposals are as following :

  • Cardiac Murmurs

    • All cardiac murmurs need to be evaluated with an ECG (resting / stress) echocardiogram / Doppler studies & cardiologists opinion to exclude structural heart disease. Unfit if Structural abnormality present.

    • Flow (innocent) murmurs

    •  2D Doppler echocardiography will be required in cases of doubt.

    Bicuspid Aortic Valve

     In view of the risk of progression to aortic stenosis or regurgitation or both & endocarditis, they are considered unfit for commercial flying duties

    Rheumatic Mitral Stenosis

    Rheumatic mitral stenosis and / or regurgitation, once diagnosed, is disqualifying for commercial flying duties.

    Mitral Valve Prolapse

    Mitral Valve Prolapse is disqualifying for civil pilot licensing.

    ECG Abnormalities

    Atrial and Ventricular Premature Beats

     Holter monitoring should be carried out to seek the possibility of sino-atrial disease. Ventricular premature beats are also usually harmless if infrequent and unifocal, and present in an otherwise normal heart. Evidence of multiformity, couplets and ventricular tachycardia will be considered unfit.

    Atrio-ventricular block

    First degree atrio-ventricular block is common in fit young men and the PR interval may be > 200 ms in the presence of a bradycardia. In the absence of a bundle branch disturbance the situation is most often benign. Occasionally very long PR intervals are seen, up to 400 ms, which shorten on exercise and with atropine and are likely to represent an exaggerated vagal phenomenon. Subjects who demonstrate shortening of the PR-interval to <200 ms with exercise / atropine, may be assessed as fit.

    The co-existent presence of a bundle branch disturbance suggests distal conducting tissue disease, particularly if right or left bundle branch block is present with left or right axis deviation.  An electrophysiological study, if carried out should show normal conduction velocities within the normal range. Evidence of distal conducting tissue disease on electrophysiological study or the presence of Mobitz Type II, 2:1 and 3:1 atrio-ventricular block [or] complete congenital atrio-ventricular block is disqualifying.

    Right bundle branch block (RBBB)

     Stress ECG, Stress echocardiography / Doppler echocardiography may be needed to demonstrate absence of structural heart disease. Fit thereafter.

    Left Bundle Branch Block (LBBB)

    Complete / Incomplete left bundle branch block is an uncommon problem in otherwise healthy humans may be due to co-existent coronary artery disease and needs to be excluded Stress ECG, Stress echocardiography / Doppler echocardiography may be needed to demonstrate absence of structural heart disease. Coronary angiography is indicated should there be any doubt about the result of noninvasive investigations & an electro-physiological study may be needed for fitness for commercial flying.

     

    Respiratory Disorders

    Pulmonary Function Test (PFT) is of assistance in differentiating Restrictive or Obstructive impairment of the respiratory system. The PFT measures lung volumes and estimates air flow dynamics e.g.  Vital Capacity (VC), Forced Vital Capacity (FVC), Forced Expiratory Volume (in the first second (FEV1) and the Peak Expiratory Flow Rate. Significant changes in volumes or flow patterns, particularly changes in the FEV1/FVC ratio should lead to further investigation. Where indicated, the diagnostic efficiency of these function tests can be heightened by measuring the response of lung function to both severe exercise and the administration of a metered dose of a bronchodilator; it is the absolute change in FEV1 following a bronchodilator which is important. An increase in FEV1 of 15% or more is very suggestive of an underlying asthmatic tendency.

    COPD All applicants with chronic obstructive airways disease due to Chronic Bronchitis and / or Emphysema require careful and individual evaluation and assessment. In general though, all applicants for initial Class 1 and Class 2 certificates with an established history of COPD requiring continuous medication shall be assessed as unfit. Class 1 and Class 2 certificate holders whose disease is mild, who have only very minor impairment of lung function, are symptomless, require no medication, and have no radiological evidence of bullae, may usually be assessed as fit. Increased medical scrutiny may be required. Inter-current infections require a temporarily unfit assessment for appropriate treatment. Smoking cessation cannot be over emphasized.

    Bronchial Asthma Initial applicants for Class 2 certification with a history of pre-existent asthma may be assessed as fit by the AME provided that the applicant demonstrates:

                  i.       A acceptable pulmonary function tests (FEV1/FVC ratio >75%);

               ii.      Treatment limited to medication compatible to flight safety (inhaled corticosteroid or inhaled beta agonist or any combination of two, or inhaled cromoglycate, but no systemic steroids);

              iii.      Absence of bronchospasm on clinical examination;

              iv.      Bronchospasm associated with mild respiratory infections easily controlled;

                v.      Acceptable personal and family history with regard to asthma (with regard to age of onset, frequency of severity of attacks, hospital admissions, loss of schooling and requirement for medication ) and other atopic states;

    Pulmonary Tuberculosis: Acceptable if drug therapy has been completed without side effects / complications, no underlying lung damage is demonstrated in the X-Ray chest and the Pulmonary Function Tests are normal.

    Digestive Disorders

                                 (i)      Peptic oesophagitis / Oesophageal hiatus hernia with reflux oesophagitis are both associated with gastric or acid irritation of the oesophageal tissue, which usually present as pain. Symptoms and / or treatment require a temporarily unfit assessment until satisfactorily recovered. Oesophageal stricture may result from long term inflammation and cause regurgitation. It is disqualifying unless successfully treated.

                               (ii)      Oesophageal varices are associated with advanced cirrhosis of the liver and risk of upper gastrointestinal haemorrhage and are disqualifying.

                             (iii)      Any gastritis or definite ulceration requiring treatment requires a temporarily unfit assessment until recovery has been demonstrated. Confirmation of healing must be shown objectively.  If surgical treatment of a bleeding or perforated ulcer is required, the individual must be asymptomatic three months later with demonstrated healing before fit assessment.

                             (iv)      Haemorrhoids may be acutely uncomfortable and can cause bleeding. Any acute haemorrhoidal inflammation requires a temporarily unfit assessment until it is asymptomatic. If surgery is required, a temporarily unfit assessment will be necessary to ascertain full recovery.

                               (v)       Recurrent or chronic pancreatitis which is idiopathic, drug or alcohol induced is disqualifying due to its unpredictable and incapacitating nature.

                             (vi)       Hepatic conditions may be acute, chronic, infective, toxic or obstructive. Applicants with any acute inflammation for whatever reason, require a temporarily unfit assessment and may be considered for a fit assessment when asymptomatic, non-infectious and with normal liver function

                           (vii)      Gilbert’s Disease (congenital unconjugated hyperbilirubinaemia) is acceptable for certification as may be minor liver function test abnormalities which are not supported by a clinical history.

                         (viii)      Biliary calculi. A single, large, asymptomatic gall stone which has been discovered by chance may be acceptable. However, multiple gall stones, whether symptomatic or asymptomatic, is potential causes of incapacitation and require treatment. Cholecystectomy, whether performed via intra-abdominal or laparoscopic surgical procedures, requires adequate recovery appropriate to the procedure before a fit assessment can be considered. Abdominal surgery is disqualifying for a minimum period of three months.

                             (ix)       Herniae require assessment against the possibility of barometric pressure changes and subsequent strangulation giving rise to incapacitating symptoms. Surgical correction is necessary before certifying fitness.

     

    Endocrine Disorders

                                 (i)      A hyperthyroid or hypothyroid pilot is unfit for flying and must remain so until a stable euthyroid state has been attained. A fit assessment may be considered in any category when they are euthyroid. Endocrinological review is mandatory at renewal medical examination. Thyroxine is permitted for pilots stabilized on the medicine & have achieved euthyroid status with the medicine. Medication is not permitted for control hyperthyroidism & will be assessed as unfit till euthyroid status is achieved without medicine & no complications / sequelae.

                               (ii)       Type 1 diabetics requiring exogenous insulin are unfit to fly.  Type 2 diabetics fully controlled on diet alone may be assessed as fit for Class 1 without limitations, subject to detailed follow-up at periodic medical examinations or at least annually. These candidates are unfit for initial issue of license medical examination, Class 1 & 2.

                             (iii)      Asymptomatic Hyperuricaemia is especially common in overweight and hypertensive men who may be taking diuretics. General health measures such as weight reduction, alcohol restriction, and a review of need for diuretic treatment should be attempted. Not a cause for temporary or permanent unfitness for commercial flying duties.

                             (iv)      Polycystic Kidneys are frequently asymptomatic & discovered incidentally; potential for progression to acute colic, UTI, development of hypertension & renal failure, precludes a fitness for Class 1& 2 medical examination.

    Pregnancy is a normal physiological process with major anatomical and hormonal changes associated with it which increase the risk of incapacitation.  Continuous antenatal care is vital to the early detection of abnormalities and so monthly assessments are required to maintain aeromedical fitness up to twenty four weeks of pregnancy, provided the following symptoms do not occur.

                           (i)            Faintness, dizziness or vertigo

                         (ii)            Nausea or vomiting

                       (iii)            Anaemia (haemoglobin 10 g/dl or less)

                       (iv)            Glycosuria or proteinuria

                         (v)            Urinary tract infection

                       (vi)            Any kind of vaginal bleeding (including ‘spotting’).

                     (vii)            Abdominal pain

                   (viii)            High blood pressure

    Beyond this point, temporary unfitness is granted, up to eight weeks after a normal delivery. Reassessment of the pilot may be done after this, to validate fitness for flying duties. Cases of cesarean section will be considered on individual basis, as highlighted in the CAR on Abdominal Surgery (6 / 2007).

    Menstrual Disorders: Dysmenorrhoea or pre-menstrual syndrome requiring medication may be permitted flying duties after the condition has regressed and the pilot is off drugs.  The use of oral contraceptives is acceptable after an initial ground trial to ensure that side effects are minimal.

     

    Haematology

                                 (i)      Hb below 13 gm % in male and 11.5 gm % in females requires an unfit assessment and further tests as clinically indicated. Final assessment depends on the diagnosis and response to treatment.

                               (ii)       In case of thalassaema minor or haemoglobinopathies with full functional capability, but without history of crises (sickle cell anaemia) a fit assessment may be considered.

                             (iii)       Applicants with a haematologic neoplasia should be denied a fit assessment.

     

    Orthopedics

                                 (i)      The Shoulder Complex. History of recurrent posterior dislocation and habitual dislocation are not acceptable for flying.

                               (ii)       The Elbow.  Restriction of forearm rotation dye to mal union or dysfunction of ulna-radio joint is unacceptable.  Full pronation of forearm is essential for correct use of control switches.

                             (iii)       The Hand and Wrist.  Grasping, pinching and hooking are the basic functions which should not be compromised.  Chronic painful hand conditions mitigate safe aircraft control.

                             (iv)      The Hip.  At least 90 deg of pain free flexion from a neutral position is essential.  Abnormal gait and shortening of limb are to be noted.

                               (v)       The Knee.  A knee with symptoms of pain, locking or instability is not commensurate with flying duties.

                             (vi)       The Ankle & Foot.  Full range of painless and stable movement the ankle and sub-talar joints are required for safe control of aircraft.