6.3.2
Physical and mental
requirements
The medical
examination shall be based on the following
requirements.
6.3.2.1
The
applicant shall not suffer from any disease
or disability which could render that
applicant likely to become suddenly unable
either to operate an aircraft safely or to
perform assigned duties safely.
6.3.2.2
The
applicant shall have no established medical
history or clinical diagnosis of:
a)
a psychosis;
b)
alcoholism;
c)
drug
dependence;
d)
any
personality disorder,
particularly if severe enough to have
repeatedly resulted in overt acts;
e)
a
mental abnormality,
or neurosis of a significant degree;
such as
might render the applicant unable to safely
exercise the privileges of the licence
applied for or held, unless accredited
medical conclusion indicates that in special
circumstances, the applicant’s failure to
meet the requirement is such that exercise
of the privileges of the licence applied for
is not likely to jeopardize flight safety.
6.3.2.2.1
Recommendation.— The applicant
should have no established medical
history or clinical diagnosis of any mental
abnormality, personality disorder or
neurosis which, according to accredited
medical conclusion, makes it likely that
within two years of the examination the
applicant will be unable to safely exercise
the privileges of the licence or rating
applied for or held.
Note.— A
history of acute toxic psychosis need not be
regarded as disqualifying, provided that the
applicant has suffered no permanent
impairment.
6.3.2.3 The
applicant shall have no established medical
history or clinical diagnosis of any of the
following:
a)
a
progressive or non-progressive disease of
the nervous system,
the effects of which, according to
accredited
medical
conclusion, are likely to interfere with the
safe exercise of the applicant’s licence and
rating privileges;
b)
epilepsy;
c)
any
disturbance of consciousness without
satisfactory medical explanation of cause.
6.3.2.4
Cases of
head injury,
the effects of which, according to
accredited medical conclusion, are likely to
interfere with the safe exercise of the
applicant’s licence and rating privileges
shall be assessed as unfit.
6.3.2.5
The
applicant shall not possess any abnormality
of the heart,
congenital or acquired, which is likely to
interfere with the safe exercise of the
applicant’s licence and rating privileges. A
history of proven myocardial infarction
shall be disqualifying.
Note.— Such
commonly occurring conditions as respiratory
arrhythmia, occasional extrasystoles which
disappear on exercise, increase of pulse
rate from excitement or exercise, or a slow
pulse not associated with
auriculoventricular dissociation may be
regarded as being within “normal” limits.
6.3.2.5.1
Electrocardiography
shall form part of the heart
examination for the first issue of a licence
and shall be included in re-examinations of
applicants between the ages of 30 and 40 no
less frequently than every two years, and
thereafter no less frequently than annually.
Note 1.—
The purpose of routine electrocardiography
is case finding. It does not provide
sufficient evidence to justify
disqualification without further thorough
cardiovascular investigation.
Note
2.— Guidance on resting and exercise
electrocardiography is published in the
Manual of Civil Aviation Medicine
(Doc 8984).
6.3.2.6 The
systolic and diastolic
blood pressures shall be within
normal limits.
Note 1.—
The use of drugs for control of high blood
pressure is disqualifying except for those
drugs, the use of which, according to
accredited medical conclusion, is compatible
with the safe exercise of the applicant’s
licence and rating privileges.
Note
2.— Extensive guidance on the subject is
published in the
Manual of Civil Aviation Medicine (Doc
8984).
6.3.2.7
There shall
be no significant functional nor structural
abnormality of the circulatory tree.
6.3.2.8
There shall
be no acute disability
of the lungs nor any active disease
of the structures of the lungs, mediastinum
or pleura. Radiography shall form a part of
the medical examination in all doubtful
clinical cases.
6.3.2.8.1 Recommendation.—
Radiography should form a part of the
initial chest examination and should be
repeated periodically thereafter.
6.3.2.9
Any
extensive mutilation of the chest wall with
collapse of the thoracic cage and sequelae
of surgical procedures resulting in
decreased respiratory efficiency at altitude
shall be assessed as unfit.
6.3.2.10
Recommendation.—
Cases of
pulmonary emphysema should be assessed as
unfit if the condition is causing symptoms.
6.3.2.11
Cases of
active pulmonary tuberculosis, duly
diagnosed, shall be assessed as unfit. Cases
of quiescent or healed lesions which are
known to be tuberculous, or are presumably
tuberculous in origin, may be assessed as
fit.
Note 1.—
Guidance material on assessment of
respiratory diseases is published in the
Manual of Civil Aviation Medicine
(Doc 8984).
Note
2.— Guidance material on hazards of
medications is published in the
Manual of Civil Aviation Medicine (Doc
8984).
6.3.2.12
Cases of
disabling disease with important impairment
of function of the
gastrointestinal tract or its adnexae
shall be assessed as unfit.
6.3.2.13
The
applicant shall be required to be completely
free from those
hernias that might give rise to
incapacitating symptoms.
6.3.2.14
Any
sequelae of disease or surgical intervention
on any part of the digestive tract or its
adnexae, likely to cause incapacity in
flight, in particular any obstructions due
to stricture or compression shall be
assessed as unfit.
6.3.2.14.1
Recommendation.— An applicant who
has undergone a major surgical
operation on the biliary passages or the
digestive tract or its adnexae, which has
involved a total or partial excision or a
diversion of any of these organs should be
assessed as unfit until such time as the
medical authority designated for the purpose
by the Contracting State and having access
to the details of the operation concerned
considers that the effects of the operation
are not likely to cause incapacity in the
air.
6.3.2.15
Cases of
metabolic, nutritional
or endocrine disorders likely to
interfere with the safe exercise of the
applicant’s licence and rating privileges
shall be assessed as unfit.
6.3.2.16
Proven
cases of diabetes
mellitus shown to be satisfactorily
controlled without the use of any
anti-diabetic drug, may be assessed as fit.
6.3.2.17
Cases of
severe and moderate enlargement of the
spleen persistently below the costal margin
shall be assessed as unfit.
6.3.2.18
Cases of significant localized and
generalized enlargement of the lymphatic
glands and of diseases of the blood shall be
assessed as unfit, except in cases where
accredited medical conclusion indicates that
the condition is not likely to affect the
safe exercise of the applicant’s licence and
rating privileges.
Recommendation.—
Possession
of the sickle
cell trait
should not be a reason for disqualification
unless there is positive medical evidence to
the contrary.
Recommendation.—
Cases in
6.3.2.18 due to
a transient
condition should be assessed as only
temporarily unfit.
6.3.2.19
Cases
presenting any signs of organic disease of
the kidney
shall be assessed as unfit; those due to a
transient condition may be assessed as
temporarily unfit. The urine shall contain
no abnormal element considered by the
medical exam- iner to be of pathological
significance. Cases of affections of the
urinary passages and of the genital organs
shall be assessed as unfit; those due to a
transient condition may be assessed as
temporarily unfit.
6.3.2.20
Any sequelae of disease or surgical
procedures on the kidneys and the urinary
tract likely to cause incapacity, in
particular any obstructions due to stricture
or compression, shall be assessed as unfit.
Compensated nephrectomy without hypertension
or uraemia may be assessed as fit.
Recommendation.—
An
applicant who has
undergone a
major surgical operation on the urinary
system which has involved a total or partial
excision or a diversion of any of its organs
should be assessed as unfit until such time
as the medical authority designated for the
purpose by the Contracting State and having
access to the details of the operation
concerned considers that the effects of the
operation are not likely to cause incapacity
in the air.
6.3.2.21
An
applicant for the first issue of a licence
who has a personal history of syphilis shall
be required to furnish evidence,
satisfactory to the medical examiner, that
the applicant has undergone adequate
treatment.
6.3.2.22
Applicants who have a history of severe
menstrual disturbances
that have proved unamenable to treatment and
that are likely to interfere with the safe
exercise of the applicant’s licence and
rating privileges shall be assessed as
unfit.
Recommendation.—
Applicants
who have
undergone
gynaecological operations should be
considered individually.
6.3.2.23
Pregnancy shall
be a cause of temporary unfitness.
Recommendation.—
In the
absence of significant abnormalities,
accredited medical conclusion may indicate
fitness during the middle months of
pregnancy.
6.3.2.24
Following confinement or termination of
pregnancy, the applicant shall not be permitted
to exercise the privileges of her licence until
she has undergone re- examination and has been
assessed as fit.
6.3.2.25
Any active
disease of the bones, joints, muscles or tendons
and all serious functional sequelae of
congenital or acquired disease shall be assessed
as unfit. Functional after- effects of lesion
affecting the bones, joints, muscles or tendons
and certain anatomical defects compatible with
the safe exercise of the applicant’s licence and
rating privileges may be assessed as fit.
6.3.2.26
There shall be:
a)
no active
pathological process, acute or chronic, of the
internal ear or of the middle ear;
b)
no unhealed (unclosed) perforation of the
tympanic membranes. A single dry perforation
need not render the applicant unfit. Licences
shall not be issued or renewed in these
circumstances unless the appropriate hearing
requirements in 6.3.4 are complied with;
c)
no permanent
obstruction of the Eustachian tubes;
d)
no permanent
disturbances of the vestibular apparatus.
Transient conditions may be assessed as
temporarily unfit.
Note.—
The details of the hearing requirements are set
out in 6.3.4.
6.3.2.27
There shall be free nasal air entry on both
sides. There shall be no serious malformation
nor serious, acute or chronic affection of the
buccal cavity or upper respiratory tract. Cases
of speech defects and stuttering shall be
assessed as unfit.
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