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The European Aviation Medical – Class 1 and Class 2

(Reviewed on 21st January 2021)

All pilots have to undergo a medical examination at regular intervals. Even student pilots will be required to have a medical certificate before they go solo. Commercial pilots (CPL) are required to pass a Class 1 medical examination. Private pilots (PPL) are required to pass a Class 2 examination.

A pilot’s licence or a student pilot’s licence is not valid if the medical certificate is not current. Student pilots must decide if they are going to require a Class 1 or a Class 2 medical certificate issued in accordance with Part-FCL and they should consult with their instructor for advice. A list of Authorised Medical Examiners (AMEs) may be found at the IAA website.

All Class 1 medical examinations can only be carried out at the Aeromedical facility at the Mater Private Hospital in Dublin.

Class 2 medicals may be carried out be any AME located throughout the country.

How long does a medical certificate last?

This depends on the class of medical and your age. Refer to the following table:

Decrease in Medical Fitness

If you are aware of any decrease in your medical fitness that may affect the safety of the flight, you are not permitted to fly as Pilot in Command or as co-pilot in an aircraft. If you are required to take any prescribed or non-prescribed medication, it is up to you to ensure that the medication will not adversely affect your flying ability.

Holders of medical certificates shall, without undue delay, seek the advice of an Aeromedical Centre (AMC) or an AME when becoming aware of:

• hospital or clinic admission for more than 12 hours
• surgical operation or invasive procedure
• the regular use of medication
• the need for regular use of correcting lenses

Holders of medical certificates who are
aware of:

• any significant personal injury involving incapacity to function as a member of a flight crew; or
• any illness involving incapacity to function as a member of a flight crew throughout a period of 21 days or more; or
• being pregnant

must inform the Authority in writing of the injury or pregnancy, and as soon as the period of 21 days has elapsed in the case of illness. The medical certificate will be deemed to be suspended upon the occurrence of any such injury or the elapse of such period of illness or the confirmation of the pregnancy, and:

1. in the case of injury or illness, the suspension will be lifted once you have been medically examined under arrangements made by the Authority and being pronounced fit to function as a member of the flight crew, or upon the Authority exempting, subject to such conditions as it thinks fit, the holder from the requirement of a medical examination; and
2. in the case of pregnancy, the suspension may be lifted by the Authority for such period and subject to such conditions as it thinks fit and will cease once you have been medically examined under arrangements made by the Authority after the pregnancy has ended and being pronounced fit to resume your functions as a member of the flight crew.

Revalidation of Medical Certificate

The medical certificate may be revalidated up to 45 days before the expiry date.

Use of Medical Treatments

Any procedure requiring the use of a general or spinal anesthetic will render the medical certificate void for a period of at least 48 hours and shall inform the AME or AMC.

Any procedure requiring the use of a local or regional anesthetic will render the medical certificate void for a period of at least 12 hours and shall inform the AME or AMC.

Validity of medical certificates

Class 1

• If a licence holder allows his Medical Certificate to expire by more than five years, renewal shall require an initial or extended, at AMS discretion, aeromedical examination, performed at an AMC which has obtained his medical records. (EEG may be omitted unless clinically indicated.)
• If a licence holder allows his Medical Certificate to expire by more than two years but less than five years, renewal shall require the prescribed standard or extended examination to be performed at an AMC which has obtained his medical file, or by an AME at the discretion of the AMS, subject to the records of medical examinations for flight crew licences being made available to the medical examiners.
• If a licence holder allows his certificate to expire by more than 90 days but less than two years, renewal shall require the prescribed standard or extended examination to be performed at an AMC, or by an AME at the discretion of the AMS.
• If a licence holder allows his certificate to expire by less than 90 days, renewal shall be possible by standard or extended examination as prescribed.

Class 2

• If an Instrument Rating is added to the licence, pure tone audiometry must have been performed within the last 60 months if the licence holder is 39 years of age or younger, and within the last 24 months if the licence holder is 40 years of age or older.
• If a licence holder allows his Medical Certificate to expire by more than five years, renewal shall require an initial aeromedical examination. Prior to the examination the medical file shall be obtained by the AME.
• If a licence holder allows his Medical Certificate to expire by more than one year but less than five years, renewal shall require the prescribed examination to be performed. Prior to the examination the medical file shall be obtained by the AME.
• If a licence holder allows his certificate to expire by less than one year, renewal shall require the prescribed examination to be performed.

An extended aeromedical examination shall always be considered to contain a standard aeromedical examination and thus count both as a standard and an extended examination.

The following paragraphs are taken from PART FCL and provide more detail in what is involved in the medical examination.

The CLASS 1 Medical Examination

The Class 1 medical is the most stringent of the medical examinations you will have to take. In Ireland, this must be done in the Mater Private Hospital in Dublin. If you are getting your first (initial) Class 1, make sure that you tell the secretary that this is going to be an initial when you are booking it. Allow at least 1 month to ensure a reservation as they are very busy. Also, book a day of work as this is going to take a long time.

Some of the tests you will undergo for the initial medical are:

• Chest X-Ray
• Hearing tests
• Urine
• Blood Sample
• Eye tests (including colour blindness test)
• Full body examination
• EEG
• ECG

Bring some form of photo ID and be prepared to answer some pretty personal questions about your medical history.

Cardiovascular system – Examination

• An applicant for or holder of a Class 1 medical certificate shall not possess any abnormality of the cardiovascular system, congenital or acquired, which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• A standard 12-lead resting electrocardiogram (ECG) and report are required at the examination for first issue of a medical certificate, then every 5 years until age 30, every 2 years until age 40, annually until age 50, and every 6 months thereafter and on clinical indication.
• Estimation of serum/plasma lipids, including cholesterol, is required to facilitate risk assessment at the examination for first issue of a medical certificate, and at the first examination after age 40.

Cardiovascular system – Blood pressure

• When the blood pressure at examination consistently exceeds 160 mmHg systolic and/or 95 mmHg diastolic, with or without treatment, the applicant shall be assessed as unfit.
• Treatment for the control of blood pressure shall be compatible with the safe exercise of the privileges of the applicable licence(s) The initiation of drug therapy shall require a period of temporary suspension of the medical certificate to establish the absence of significant side effects.
• Applicants with symptomatic hypotension shall be assessed as unfit.

Cardiovascular system – Coronary artery disease

• Applicants with suspected coronary artery disease shall be investigated. Applicants with asymptomatic minor coronary artery disease, requiring no treatment may only be considered fit by the AMS subject to certain conditions.
• Applicants with symptomatic coronary artery disease shall be assessed as unfit.
• Applicants following myocardial infarction shall be assessed as unfit at the initial examination. A fit assessment may be considered by the AMS at renewal and revalidation examinations subject to certain conditions.
• Applicants following coronary by-pass surgery or coronary angioplasty/stenting shall be assessed as unfit at the initial examination. A fit assessment may be considered by the AMS at renewal and revalidation examinations subject to certain conditions.

Cardiovascular system – Rhythm/conduction disturbances

• Applicants with significant disturbance of supraventricular rhythm, including sinoatrial dysfunction, whether intermittent or established, shall be assessed as unfit. A fit assessment may be considered by the AMS under specific circumstances
• Applicants with asymptomatic sinus bradycardia or sinus tachycardia may be assessed as fit in the absence of underlying abnormality.
• Applicants with asymptomatic isolated uniform atrial or ventricular ectopic complexes need not be assessed as unfit. Frequent or complex forms require full cardiological evaluation in compliance
• In the absence of any other abnormality, applicants with incomplete bundle branch block or stable left axis deviation may be assessed as fit.
• Applicants with complete right or left bundle branch block require cardiological evaluation on first presentation.
• Applicants with broad and/or narrow complex tachycardias shall be assessed as unfit. A fit assessment may be considered by the AMS subject to certain conditions.
• Applicants with an endocardial pacemaker shall be assessed as unfit. A fit assessment may be considered by the AMS subject to specific conditions.

Cardiovascular system – General

• Applicants with peripheral arterial disease before or after surgery shall be assessed as unfit. Provided there is no significant functional impairment, a fit assessment may be considered by the AMS under specific circumstances
• Applicants with aneurysm of the thoracic or abdominal aorta, before or after surgery, shall be assessed as unfit. Applicants with aneurysm of the infra-renal abdominal aorta may be considered by the AMS at renewal or revalidation examinations.
• Applicants with significant abnormality of any of the heart valves shall be assessed as unfit.
• Systemic anticoagulant therapy is disqualifying. Applicants who have received treatment of limited duration may be considered for a fit assessment by the AMS subject to specific conditions.
• Applicants with any abnormality of the pericardium, myocardium or endocardium not covered above shall be assessed as unfit. A fit assessment may be considered by the AMS following complete resolution and satisfactory cardiological evaluation.
• Applicants with congenital abnormality of the heart, before or after corrective surgery, shall be assessed as unfit. Applicants with minor abnormalities may be assessed as fit by the AMS following cardiological investigation.
• Heart or heart/lung transplantation is disqualifying.
• Applicants with a history of recurrent vasovagal syncope shall be assessed as unfit. A fit assessment may be considered by the AMS in applicants with a suggestive history.

Respiratory system – General

• An applicant for or the holder of a Class 1 medical certificate shall not possess any abnormality of the respiratory system, congenital or acquired, which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• Posterior/anterior chest radiography is required at the initial examination. It may be required at revalidation/renewal examinations when indicated on clinical or epidemiological grounds.
• Pulmonary function tests are required at the initial examination. A peak flow test shall be performed at first revalidation or renewal examination after age 30, every 5 years until age 40, and every 4 years thereafter and on clinical indication. Applicants with significant impairment of pulmonary function shall be assessed as unfit.

Respiratory system – Disorders

• Applicants with chronic obstructive airway disease shall be assessed as unfit.
• Applicants with reactive airway disease (bronchial asthma) requiring medication shall be assessed case by case.
• Applicants with active inflammatory disease of the respiratory system shall be assessed as temporarily unfit.
• Applicants with active sarcoidosis shall be assessed as unfit.
• Applicants with spontaneous pneumothorax shall be assessed as unfit pending full evaluation.
• Applicants requiring major chest surgery shall be assessed as unfit for a minimum of three months following operation and until such time as the effects of the operation are no longer likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• Applicants with unsatisfactorily treated sleep apnoea syndrome shall be assessed as unfit.

Digestive system – General

• An applicant for or the holder of a Class 1 medical certificate shall not possess any functional or structural disease of the gastro intestinal tract or its adnexa which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).

Digestive system – Disorders

• Applicants with recurrent dyspeptic disorders requiring medication or with pancreatitis shall be assessed as unfit pending assessment.
• Applicants with asymptomatic gallstones discovered incidentally shall be assessed case by case.
• Applicants with an established diagnosis or history of chronic inflammatory bowel disease shall normally be assessed as unfit.
• Applicants shall be required to be completely free from those herniae that might give rise to incapacitating symptoms.
• Applicants with any sequela of disease or surgical intervention in any part of the digestive tract or its adnexa likely to cause incapacitation in flight, in particular any obstruction due to stricture or compression, shall be assessed as unfit.
• Applicants who have undergone a surgical operation on the digestive tract or its adnexa, involving a total or partial excision or a diversion of any of these organs, shall be assessed as unfit for a minimum period of three months or until such time as the effects of the operation are no longer likely to interfere with the safe exercise of the privileges of the applicable licence(s)

Metabolic, nutritional and endocrine diseases

• An applicant for or the holder of a Class 1 medical certificate shall not possess any functional or structural metabolic, nutritional or endocrine disorder which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• Applicants with metabolic, nutritional or endocrine dysfunctions may be assessed as fit.
• Applicants with diabetes mellitus may be assessed as fit under specific circumstances.
• Applicants with diabetes requiring insulin shall be assessed as unfit.
• 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 applicable licence(s) and a satisfactory cardiovascular risk review has been undertaken.

Haematology

• An applicant for or the holder of a Class 1 medical certificate shall not possess any haematological disease which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• Haemoglobin shall be tested at every medical examination and cases of significant anaemia with a haematocrit below 32% shall be assessed as unfit.
• Applicants with sickle cell disease shall be assessed as unfit.
• Applicants with significant localised and generalised enlargement of the lymphatic glands and diseases of the blood shall be assessed as unfit.
• Applicants with acute leukaemia shall be assessed as unfit. After established remission, certification may be considered by the AMS. Initial applicants with chronic leukaemias shall be assessed as unfit.
• Applicants with significant enlargement of infections of the spleen shall be assessed as unfit.
• Applicants with significant polycythaemia shall be assessed as unfit.
• Applicants with a coagulation defect shall be assessed as unfit.

Urinary system

• An applicant for or the holder of a Class 1 medical certificate shall not possess any functional or structural disease of the urinary system or its adnexa which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• Applicants presenting any signs of organic disease of the kidney shall be assessed as unfit. Urinalysis shall form part of every medical examination. The urine shall contain no abnormal element considered to be of pathological significance. Particular attention shall be paid to disease affecting the urinary passages and the genital organs.
• Applicants presenting with urinary calculi shall be assessed as unfit.
• Applicants with any sequela of disease or surgical procedures on the kidneys and the urinary tract likely to cause incapacitation, in particular any obstruction due to stricture or compression, shall be assessed as unfit. An applicant with compensated nephrectomy without hypertension or uraemia may be considered fit.
• Applicants who have undergone a major surgical operation in the urinary tract or the urinary apparatus involving a total or partial excision or a diversion of any of its organs shall be assessed as unfit for a minimum period of three months and until such time as the effects of the operation are no longer likely to cause incapacity in flight.

Sexually transmitted diseases and other infections

• An applicant for or holder of a Class 1 medical certificate shall have no established medical history or clinical diagnosis of any sexually transmitted disease or other infection which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• Particular attention shall be paid to a history of or clinical signs indicating:

1. HIV positivity,
2. immune system impairment,
3. infectious hepatitis,
4. syphilis.

Gynaecology and obstetrics

• An applicant for or the holder of a Class 1 medical certificate shall not possess any functional or structural obstetric or gynaecological condition which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• An applicant with a history of severe menstrual disturbances unamenable to treatment shall be assessed as unfit.
• Pregnancy entails unfitness. If obstetric evaluation indicates a completely normal pregnancy, the applicant may be assessed as fit until the end of the 26th week of gestation. Licence privileges may be resumed upon satisfactory confirmation of full recovery following confinement or termination of pregnancy.
• An applicant who has undergone a major gynaecological operation shall be assessed as unfit for a minimum period of three months and until such time as the effects of the operation are not likely to interfere with the safe exercise of the privileges of the licence(s).

Musculoskeletal requirements

• An applicant for or holder of a Class 1 medical certificate shall not possess any abnormality of the bones, joints, muscles and tendons, congenital or acquired which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• An applicant shall have sufficient sitting height, arm and leg length and muscular strength for the safe exercise of the privileges of the applicable licence.
• An applicant shall have satisfactory functional use of the musculoskeletal system. An applicant with any significant sequela from disease, injury or congenital abnormality of the bones, joints, muscles or tendons with or without surgery shall be assessed case by case.

Psychiatric requirements

• An applicant for or holder of a Class 1 medical certificate shall have no established medical history or clinical diagnosis of any psychiatric disease or disability, condition or disorder, acute or chronic, congenital or acquired, which is likely to interfere with the safe exercise of the privileges of the applicable licence(s),
• Particular attention shall be paid to the following:

1. Schizophrenia, schizotypal and delusional disorders;
2. mood disorders;
3. neurotic, stress-related and somatoform disorders;
4. personality disorders;
5. organic mental disorders;
6. mental and behavioural disorders due to alcohol;
7. use or abuse of psychotropic substances.

Neurological requirements

• An applicant for or holder of a Class 1 medical certificate shall have no established medical history or clinical diagnosis of any neurological condition which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• Particular attention shall be paid to the following:

1. progressive disease of the nervous system,
2. epilepsy and other causes of disturbance of consciousness,
3. conditions with a high propensity for cerebral dysfunction,
4. head injury,
5. spinal or peripheral nerve injury.

• Electroencephalography is required at the initial examination and when indicated by the applicant’s history or on clinical grounds.

Ophthalmological requirements

• An applicant for or holder of a Class 1 medical certificate shall not possess any abnormality of the function of the eyes or their adnexa or any active pathological condition, congenital or acquired, acute or chronic, or any sequela of eye surgery or trauma, which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• An ophthalmological examination is required at the initial examination and shall include:

1. History;
2. Visual acuity, near, intermediate and distant vision: uncorrected; with best optical correction if needed;
3. Objective refraction. Hyperopic applicants under age 25 in cycloplegia;
4. Ocular motility and binocular vision;
5. Colour vision;
6. Visual fields;
7. Tonometry on clinical indication and over age 40;
8. Examination of the external eye, anatomy, media and fundoscopy. Slit lamp examination.

• A routine eye examination shall form part of all revalidation and renewal examinations and shall include:

1. History;
2. Visual acuity, near, intermediate and distant vision: uncorrected and with best optical correction if needed;
3. Morphology by ophthalmoscopy;
4. Further examination on clinical indication.

• Where, in certificate holders the functional performance standards (6/9, 6/9, 6/6, N14, N5) can only be reached with corrective lenses, the applicant shall supply to the AME an examination report from an ophthalmologist or vision care specialist acceptable to the AMS. The report must refer to an examination which was carried out at the time of the general medical examination and in any case not more than 24 months before the general medical examination. The examination shall include:

1. History;
2. Visual acuity, near, intermediate and distant vision: uncorrected; with best optical correction if needed;
3. Refraction;
4. Ocular motility and binocular vision;
5. Colour vision;
6. Visual fields;
7. Tonometry over age 40;
8. Examination of the external eye, anatomy, media and fundoscopy. Slit lamp examination.

The report shall be forwarded to the AMS. If any abnormality is detected, such that the applicant’s ocular health is in doubt, further ophthalmological examination will be required.

Visual requirements

• Distant visual acuity. Distant visual acuity, with or without 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. No limits apply to uncorrected visual acuity.
• Refractive errors. Refractive error is defined as the deviation from emmetropia measured in dioptres in the most ametropic meridian. Refraction shall be measured by standard methods. Applicants shall be considered fit with respect to refractive errors if they meet the following requirements:

1. Refractive error (i) At the initial examination the refractive error shall not exceed ±3 dioptres. (ii) At revalidation or renewal examinations, an applicant experienced to the satisfaction of the Authority with refractive errors up to +5/-8 dioptres may be considered fit by the AMS.
2. Astigmatism (i) In an initial applicant with a refractive error with an astigmatic component, the astigmatism shall not exceed 2·0 dioptres. (ii) At recertification or renewal examinations, an applicant experienced to the satisfaction of the Authority with a refractive error with an astigmatic component not exceeding 3·0 dioptres may be considered fit by the AMS.
3. Keratoconus is disqualifying. The AMS may consider re-certification if the applicant meets the visual requirements.
4. Anisometropia (i) In initial applicants the difference in refractive error between the two eyes (anisometropia) shall not exceed 2·0 dioptres. (ii) At recertification or renewal examinations, an applicant experienced to the satisfaction of the Authority with a difference in refractive error between the two eyes of up to 3·0 dioptres may be considered fit by the AMS.
5. The development of presbyopia shall be followed at all aeromedical renewal examinations.
6. An applicant shall be able to read N5 chart (or equivalent) at 30–50 cms and N14 chart (or equivalent) at 100 cms, with correction if prescribed.

• An applicant with significant defects of  binocular vision shall be assessed as unfit. There is no stereoscopic test requirement.
• An applicant with diplopia shall be assessed as unfit.
• An applicant with imbalance of the ocular muscles (heterophorias) exceeding (when measured with usual correction, if prescribed):

[2·0] prism dioptres in hyperphoria at 6 metres,
[10·0] prism dioptres in esophoria at 6 metres,
8·0 prism dioptres in exophoria at 6 metres;

and

1·0 prism dioptre in hyperphoria at 33 cms,
6·0 prism dioptres in esophoria at 33 cms,
12·0 prism dioptres in exophoria at 33 cms

shall be assessed as unfit. If the fusional reserves are sufficient to prevent asthenopia and diplopia the AMS may consider a fit assessment.

• An applicant with visual fields which are not normal shall be assessed as unfit.

1. If a visual requirement is met only with the use of correction, the spectacles or contact lenses must provide optimal visual function and be suitable for aviation purposes.
2. Correcting lenses, when worn for aviation purposes, shall permit the licence holder to meet the visual requirements at all distances. No more than one pair of spectacles shall be used to meet the requirement.
3. A spare set of similarly correcting spectacles shall be readily available when exercising the privileges of the licence.

• Eye Surgery.

1. Refractive surgery entails unfitness. Certification may be considered by the AMS.
2. Cataract surgery, retinal surgery and glaucoma surgery entail unfitness. Recertification may be considered by the AMS.

Colour perception

• Normal colour perception is defined as the ability to pass the Ishihara test or to pass Nagel’s anomaloscope as a normal trichromate.
• An applicant shall have normal perception of colours or be colour safe. Applicants who fail Ishihara’s test shall be assessed as colour safe if they pass extensive testing with methods acceptable to the AMS (anomaloscopy or colour lanterns.
• An applicant who fails the acceptable colour perception tests is to be considered colour unsafe and shall be assessed as unfit.

Otorhinolaryngological requirements

• An applicant for or holder of a Class 1 medical certificate shall not possess any abnormality of the function of the ears, nose, sinuses or throat (including oral cavity, teeth and larynx), or any active pathological condition, congenital or acquired, acute or chronic, or any sequela of surgery and trauma which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• A comprehensive otorhinolaryngological examination is required at the initial examination and subsequently once every five years up to the 40th birthday and every two years thereafter.
• A routine Ear-Nose-Throat examination shall form part of all revalidation and renewal examinations.
• Presence of any of the following disorders in an applicant shall result in an unfit assessment.

1. Active pathological process, acute or chronic, of the internal or middle ear.
2. Unhealed perforation or dysfunction of the tympanic membranes.
3. Disturbances of vestibular function.
4. Significant restriction of the nasal air passage on either side, or any dysfunction of the sinuses.
5. Significant malformation or significant, acute or chronic infection of the oral cavity or upper respiratory tract.
6. Significant disorder of speech or voice.

Hearing requirements

• 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 back turned towards the AME.
• Hearing shall be tested with pure tone audiometry at the initial examination and at subsequent revalidation or renewal examinations every five years up to the 40th birthday and every two years thereafter.
• At the initial examination for a Class 1 medical certificate there shall be no hearing loss in either ear, when tested separately, of more than 20 dB(HL) at any of the frequencies 500, 1 000 and 2 000 Hz, or of more than 35 dB(HL) at 3 000 Hz. An applicant whose hearing loss is within 5 dB(HL) of these limits in two or more of the frequencies tested, shall undergo pure tone audiometry at least annually.
• At revalidation or renewal examinations, there shall be no hearing loss in either ear, when tested separately, of more than 35dB(HL) at any of the frequencies 500, 1 000, and 2 000 Hz, or of more than 50 dB(HL) at 3 000 Hz. An applicant whose hearing loss is within 5 dB(HL) of these limits in two or more of the frequencies tested, shall undergo pure tone audiometry at least annually.
• At revalidation or renewal, applicants with hypoacusis may be assessed as fit by the AMS if a speech discrimination test demonstrates a satisfactory hearing ability.

Psychological requirements

• An applicant for or holder of a Class 1 medical certificate shall have no established psychological deficiencies which are likely to interfere with the safe exercise of the privileges of the applicable licence(s). A psychological evaluation may be required by the AMS where it is indicated as part of, or complementary to, a specialist psychiatric or neurological examination.
• When a psychological evaluation is indicated a psychologist acceptable to the AMS shall be utilised.
• The psychologist shall submit to the AMS a written report detailing his opinion and recommendation.

Dermatological requirements

• An applicant for, or holder of a Class 1 Medical Certificate shall have no established dermatological condition, likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• Particular attention should be paid to the following disorders:

1. Eczema (Exogenous and Endogenous),
2. Severe Psoriasis,
3. Bacterial Infections,
4. Drug Induced Eruptions,
5. Bullous Eruptions,
6. Malignant Conditions of the skin,
7. Urticaria. Referral to the AMS shall be made if doubt exists about any condition.

Oncology

• An applicant for or holder of a Class 1 medical certificate shall have no established primary or secondary malignant disease likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• After treatment for malignant disease applicants may be assessed as fit.

The CLASS 2 Medical Examination

Cardiovascular system – Examination

• An applicant for or holder of a Class 2 medical certificate shall not possess any abnormality of the cardiovascular system, congenital or acquired, which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• A standard 12-lead resting electrocardiogram (ECG) and report are required at the examination for first issue of a medical certificate, at the first examination after the 40th birthday and at each aeromedical examination thereafter.
• If two or more major risk factors (smoking, hypertension, diabetes mellitus, obesity, etc) are present in an applicant, estimation of plasma lipids and serum cholesterol is required at the examination for first issue of a medical certificate and at the first examination after age 40.

Cardiovascular system – Blood pressure

• Blood pressure shall be recorded.
• When the blood pressure at examination consistently exceeds 160 mmHg systolic and/or 95 mmHg diastolic with or without treatment the applicant shall be assessed as unfit.
• Treatment for the control of blood pressure shall be compatible with the safe exercise of the privileges of the applicable licence(s). The initiation of drug therapy shall require a period of temporary suspension of the medical certificate to establish the absence of significant side effects.
• Applicants with symptomatic hypotension shall be assessed as unfit.

Cardiovascular system – Coronary artery disease

• Applicants with asymptomatic, minor, coronary artery disease may be considered fit by the AMS subject to specific conditions.
• Applicants with symptomatic coronary artery disease shall be assessed as unfit.
• Applicants following myocardial infarction shall be assessed as unfit. A fit assessment may be considered by the AMS subject to specific conditions.
• Applicants following coronary bypass surgery or coronary angioplasty/stenting shall be assessed as unfit. A fit assessment may be considered by the AMS subject to specific conditions.

Cardiovascular system – Rhythm/conduction disturbances

• Applicants with disturbance of supraventricular rhythm, including sinoatrial dysfunction, whether intermittent or established shall be assessed as unfit. A fit assessment may be considered by the AMS subject to specific conditions.
• Applicants with asymptomatic sinus bradycardia or sinus tachycardia may be assessed as fit in the absence of underlying abnormality.
• Applicants with asymptomatic isolated uniform atrial or ventricular ectopic complexes need not be assessed as unfit. Frequent or complex forms require full cardiological evaluation in compliance with certain conditions.
• In the absence of any other abnormality, applicants with incomplete bundle branch block or stable left axis deviation may be assessed as fit.
• Applicants with complete right or left bundle branch block require cardiological evaluation on first presentation and subsequently in compliance with certain conditions.
• Applicants with broad and/or narrow complex tachycardias shall be assessed as unfit. A fit assessment may be considered by the AMS subject to compliance with certain conditions.
• Applicants with an endocardial pacemaker shall be assessed as unfit. A fit assessment may be considered by the AMS subject to compliance with certain conditions.

Cardiovascular system – General

• Applicants with peripheral arterial disease before or after surgery shall be assessed as unfit. Provided there is no significant functional impairment a fit assessment may be considered by the AMS subject to certain conditions.
• Applicants with aneurysm of the thoracic or abdominal aorta, before or after surgery, shall be assessed as unfit. Applicants with infra-renal abdominal aortic aneurysm may be considered fit by the AMS subject to compliance with certain conditions.
• Applicants with significant abnormality of any of the heart valves shall be assessed as unfit.

1. Applicants with minor cardiac valvular abnormalities may be assessed as fit by the AMS subject to compliance with certain conditions.
2. Applicants with cardiac valve replacement/repair shall be assessed as unfit. A fit assessment may be considered by the AMS subject to compliance with certain conditions.

• Systemic anticoagulant therapy is disqualifying. Applicants who have received treatment of limited duration, may be considered for a fit assessment by the AMS subject to compliance with certain conditions.
• Applicants with any abnormality of the pericardium, myocardium or endocardium not covered above shall be assessed as unfit. A fit assessment may be considered by the AMS following complete resolution and satisfactory cardiological evaluation in compliance with certain conditions.
• Applicants with congenital abnormality of the heart, before or after corrective surgery, shall be assessed as unfit. A fit assessment may be considered by the AMS in compliance with certain conditions.
• Heart or heart/lung transplantation is disqualifying.
• Applicants with a history of recurrent vasovagal syncope shall be assessed as unfit. A fit assessment may be considered by the AMS in an applicant with a suggestive history subject to compliance with certain conditions.

Respiratory system – General

• An applicant for or the holder of a Class 2 medical certificate shall not possess any abnormality of the respiratory system, congenital or acquired, which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• Posterior/anterior chest radiography is required only when indicated on clinical or epidemiological grounds.
• A pulmonary peak flow test is required at the initial examination, at the first examination after the 40th birthday, every four years thereafter and when clinically indicated. Applicants with significant impairment of pulmonary function shall be assessed as unfit.

Respiratory system – Disorders

• Applicants with chronic obstructive airway disease shall be assessed as unfit.
• Applicants with reactive airway disease (bronchial asthma) requiring medication shall be assessed.
• Applicants with active inflammatory disease of the respiratory system shall be assessed as temporarily unfit.
• Applicants with active sarcoidosis shall be assessed as unfit.
• Applicants with spontaneous pneumothorax shall be assessed as unfit pending full evaluation.
• Applicants requiring major chest surgery shall be assessed as unfit for a minimum of three months following operation and until such time as the effects of the operation are no longer likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• Applicants with unsatisfactorily treated sleep apnoea syndrome shall be assessed as unfit.

Digestive system – General

• An applicant for or holder of a Class 2 medical certificate shall not possess any functional or structural disease of the gastro-intestinal tract or its adnexa which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).

Digestive system – Disorders

• Applicants with dyspeptic disorders requiring medication or with pancreatitis shall be assessed as unfit pending examination.
• Applicants with asymptomatic gallstones discovered incidentally shall be assessed.
• Applicants with an established diagnosis or history of chronic inflammatory bowel disease shall normally be assessed as unfit.
• Applicants shall be required to be completely free from those hernias that might give rise to incapacitating symptoms.
• Applicants with any sequela of disease or surgical intervention on any part of the digestive tract or its adnexae likely to cause incapacitation in flight, in particular any obstruction due to stricture or compression, shall be assessed as unfit.
• Applicants who have undergone a surgical operation on the digestive tract or its adnexa, involving a total or partial excision or a diversion of any of these organs, shall be assessed as unfit for a minimum period of three months or until such time as the effects of the operation are no longer likely to interfere with the safe exercise of the privileges of the applicable licence(s).

Metabolic, nutritional and endocrine diseases

• An applicant for or holder of a Class 2 medical certificate shall not possess any functional or structural metabolic, nutritional or endocrine disorder which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• Applicants with metabolic, nutritional or endocrine dysfunctions may be assessed as fit.
• Applicants with diabetes mellitus may be assessed as fit only in accordance specific conditions.
• Applicants with diabetes requiring insulin shall be assessed as unfit.
• 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 applicable licence(s) and a satisfactory cardiovascular risk review has been undertaken.

Haematology

• An applicant for or the holder of a Class 2 medical certificate shall not possess any haematologic disease which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• Haemoglobin shall be tested at the initial examination for a medical certificate and when indicated on clinical grounds. Cases of significant anaemia with a haematocrit below 32% shall be assessed as unfit.
• Applicants with sickle cell disease shall be assessed as unfit.
• Applicants with significant localised and generalised enlargement of the lymphatic glands and diseases of the blood shall be assessed as unfit.
• Applicants with acute leukaemia shall be assessed as unfit. After established remission certification may be considered by the AMS. Initial applicants with chronic leukaemia shall be assessed as unfit.
• Applicants with significant enlargement of the spleen shall be assessed as unfit.
• Applicants with significant polycythaemia shall be assessed as unfit.
• Applicants with a coagulation defect shall be assessed as unfit.

Urinary system

• An applicant for or the holder of a Class 2 medical certificate shall not possess any functional or structural disease of the urinary system or its adnexa which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• Applicants presenting any signs of organic disease of the kidney shall be assessed as unfit. Urinalysis shall form part of every medical examination. The urine shall contain no abnormal element considered to be of pathological significance. Particular attention shall be paid to disease affecting the urinary passages and the genital organs.
• Applicants presenting with urinary calculi shall be assessed as unfit.
• Applicants with any sequela of disease or surgical procedures on the kidneys and the urinary tract likely to cause incapacitation, in particular any obstruction due to stricture or compression, shall be assessed as unfit. Applicants with compensated nephrectomy without hypertension or uraemia may be considered fit by the AMS.
• Applicants who have undergone a major surgical operation in the urinary tract or the urinary apparatus involving a total or partial excision or a diversion of any of its organs shall be assessed as unfit for a minimum period of three months and until such time as the effects of the operation are no longer likely to interfere with the safe exercise of the privileges of the applicable licence(s).

Sexually transmitted diseases and other infections

• An applicant for or holder of a Class 2 medical certificate shall have no established medical history or clinical diagnosis of any sexually transmitted disease or other infection which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• Particular attention shall be paid to a history of or clinical signs indicating :

1. HIV positivity,
2. immune system impairment,
3. infectious hepatitis,
4. syphilis.

Gynaecology and obstetrics

• An applicant for or the holder of a Class 2 medical certificate shall not possess any functional or structural obstetric or gynaecological condition which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• An applicant with a history of severe menstrual disturbances unamenable to treatment shall be assessed as unfit.
• Pregnancy entails unfitness. If obstetric evaluation indicates a completely normal pregnancy, the applicant may be assessed as fit until the end of the 26th week of gestation. Licence privileges may be resumed upon satisfactory confirmation of full recovery following confinement or termination of pregnancy.
• An applicant who has undergone a major gynaecological operation shall be assessed as unfit for a minimum period of three months and until such time as the effects of the operation are not likely to interfere with the safe exercise of the privileges of the licence(s).

Musculoskeletal requirements

• An applicant for or holder of a Class 2 medical certificate shall not possess any abnormality of the bones, joints, muscles and tendons, congenital or acquired which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• An applicant shall have sufficient sitting height, arm and leg length and muscular strength for the safe exercise of the privileges of the applicable licence.
• An applicant shall have satisfactory functional use of the musculo-skeletal system. An applicant with any significant sequela from disease, injury or congenital abnormality of the bones, joints, muscles or tendons with or without surgery shall be assessed case by case.

Psychiatric requirements

• An applicant for or holder of a Class 2 medical certificate shall have no established medical history or clinical diagnosis of any psychiatric disease or disability, condition or disorder, acute or chronic, congenital or acquired, which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• Particular attention shall be paid to the following:

1. schizophrenia, schizotypal and delusional disorders;
2. mood disorders;
3. neurotic, stress-related and somatoform disorders;
4. personality disorders;
5. organic mental disorders;
6. mental and behavioural disorders due to alcohol;
7. use or abuse of psychotropic  substances.

Neurological requirements

• An applicant for or holder of a Class 2 medical certificate shall have no established medical history or clinical diagnosis of any neurological condition which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• Particular attention shall be paid to the following:

1. progressive disease of the nervous system,
2. epilepsy and other causes of disturbance of consciousness,
3. conditions with a high propensity for cerebral dysfunction,
4. head injury,
5. spinal or peripheral nerve injury.

Ophthalmological requirements

• An applicant for or holder of a Class 2 medical certificate shall not possess any abnormality of the function of the eyes or their adnexa or any active pathological condition, congenital or acquired, acute or chronic, or any sequela of eye surgery or trauma, which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• An ophthalmological examination is required at the initial examination and shall include:

1. History;
2. Visual acuity, near and distant vision; uncorrected; with best optical correction if needed;
3. Ocular motility and binocular vision;
4. Colour vision;
5. Visual fields;
6. Examination of the external eye, anatomy, media and fundoscopy.

• A routine eye examination shall form part of all revalidation and renewal examinations and shall include:

1. History;
2. Visual acuity, near and distant vision: uncorrected; with best optical correction if needed;
3. Examination of the external eye, anatomy, media and fundoscopy
4. Further examination on clinical indication

Visual requirements

• Distant visual acuity. Distant visual acuity, with or without correction, shall be 6/12 (0,5) or better in each eye separately and  visual acuity with both eyes shall be 6/6 (1,0) or better. No limits apply to uncorrected visual acuity.
• Refractive errors. Refractive error is defined as the deviation from emmetropia measured in dioptres in the most ametropic meridian. Refraction shall be measured by standard methods. Applicants shall be considered fit with respect to refractive errors if they meet the following requirements.

1. Refractive error. (i) At the initial examination the refractive error shall not exceed ±5 dioptres. (ii) At recertification or renewal examinations, an applicant experienced to the satisfaction of the Authority with refractive errors up to + 5/-8 dioptres may be considered fit by the AMS.
2. Astigmatism. (i) In an initial applicant with a refractive error with an astigmatic component, the astigmatism shall not exceed 3·0 dioptres. (ii) At recertification or renewal examinations, an applicant experienced to the satisfaction of the Authority with a refractive error with an astigmatic component of more than 3·0 dioptres may be considered fit by the AMS.
3. Keratoconus is disqualifying. The AMS may consider re-certification if the applicant meets the visual requirements.
4. In an applicant with amblyopia, the visual acuity of the amblyopic eye shall be 6/18 (0/32) or better. The applicant may be accepted as fit provided the visual acuity in the other eye is 6/6 or better and no pathology (including refractive error) can be demonstrated.
5. Anisometropia. (i) In an initial applicant the difference in refractive error between thetwo eyes (anisometropia) shall not exceed 3·0 dioptres. (ii) At recertification or renewal examinations, an applicant experienced to the satisfaction of the Authority with a difference in refractive error between the two eyes (anisometropia) of more than 3·0 dioptres may be considered fit by the AMS. Contact lenses shall be worn if the anisometropia exceeds 3·0 dioptres.
6. The development of presbyopia shall be followed at all aeromedical renewal examinations.
7. An applicant shall be able to read N5 chart (or equivalent) at 30–50 cms and N14 chart (or equivalent) at 100 cms, with correction if prescribed.

• An applicant with significant defects of binocular vision shall be assessed as unfit. There is no stereoscopic test requirement.
• An applicant with diplopia shall be assessed as unfit.
• An applicant with visual fields which are not normal shall be assessed as unfit.

1. If a visual requirement is met only with the use of correction, the spectacles or contact lenses must provide optimal visual function and be suitable for aviation purposes.
2. Correcting lenses, when worn for aviation purposes, shall permit the licence holder to meet the visual requirements at all distances. No more than one pair of spectacles shall be used to meet the requirements.
3. A spare set of similarly correcting spectacles shall be readily available when exercising the privileges of the licence.

• Eye Surgery.

1. Refractive surgery entails unfitness. Certification may be considered by the AMS.
2. Cataract surgery, retinal surgery and glaucoma surgery entail unfitness. Recertification may be considered by the AMS.

Colour perception

• Normal colour perception is defined as the ability to pass Ishihara’s test or to pass Nagel’s anomaloscope as a normal trichromate.
• An applicant shall have normal perception of colours or be colour safe. Applicants who fail Ishihara’s test may be assessed as colour safe if they pass extensive testing with methods acceptable to the AMS (anomaloscopy or colour lanterns).
• An applicant who fails the acceptable colour perception tests is to be considered colour unsafe and shall be assessed as unfit.
• A colour unsafe applicant may be assessed by the AMS as fit to fly by day only.

Otorhinolaryngological requirements

• An applicant for or holder of a Class 2 medical certificate shall not possess any abnormality of the function of the ears, nose, sinuses, or throat (including oral cavity, teeth and larynx), or any active pathological condition, congenital or acquired, acute or chronic, or any sequela of surgery and trauma which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• A comprehensive otorhinolaryngological examination by an AME is required at the initial examination.
• A routine Ear-Nose-Throat examination shall form part of all revalidation and renewal examinations.
• Presence of any of the following disorders in an applicant shall result in an unfit assessment.

1. Active pathological process, acute or chronic, of the internal or middle ear.
2. Unhealed perforation or dysfunction of the tympanic membranes.
3. Disturbances of vestibular function.
4. Significant restriction of the nasal air passage on either side, or any dysfunction of the sinuses.
5. Significant malformation or significant, acute or chronic infection of the oral cavity or upper respiratory tract.
6. Significant disorder of speech or voice.

Hearing requirements

• Hearing shall be tested at all examinations. The applicant shall be able to understand correctly ordinary conversational speech when at a distance of 2 metres from and with his back turned towards the AME.
• If an instrument rating is to be added to the applicable licence(s), a hearing test with pure tone audiometry is required at the first examination for the rating and shall be repeated every 5 years up to the 40th birthday and every 2 years thereafter.

1. At the initial examination for a Class 2 medical certificate with instrument ratings there shall be no hearing loss in either ear, when tested separately, of more than 20 dB(HL) at any of the frequencies 500, 1 000 and 2 000 Hz, or of more than 35 dB(HL) at 3 000 Hz. An applicant whose hearing loss is within 5 db (HL) of these limits in two or more of the frequencies tested shall undergo pure tone audiometry at least annually.
2. At recertification or renewal examinations there shall be no hearing loss in either ear, when tested separately of more than 35 db (HL) at any of the frequencies 500, 1 000, and 2 000 Hz, or more than 50 db (HL) at 3 000 Hz. An applicant whose hearing loss is within 5 db (HL) of these limits in two or more of the frequencies tested shall undergo pure tone audiometry at least annually.
3. At recertification or renewal examinations applicants with hypoacusis may be assessed as fit by the AMS if a speech discrimination test demonstrates a satisfactory hearing ability.

Psychological requirements

• An applicant for or holder of a Class 2 medical certificate shall have no established psychological deficiencies, particularly in operational aptitudes or any relevant personality factor, which are likely to interfere with the safe exercise of the privileges of the applicable licence(s). A psychological evaluation may be required by the AMS where it is indicated as part of, or complementary to, a specialist psychiatric or neurological examination.
• When a psychological evaluation is indicated a psychologist acceptable to the Authority shall be utilised.
• The psychologist shall submit to the AMS a written report detailing his opinion and recommendation.

Dermatological requirements

• An applicant for or holder of a Class 2 Medical Certificate shall have no established dermatological condition, likely to interfere with the safe exercise of the privileges of the applicable licence(s).
• Particular attention should be paid to the following disorders:

1. Eczema (Exogenous and Endogenous),
2. Severe Psoriasis,
3. Bacterial Infections,
4. Drug Induced Eruptions,
5. Bullous Eruptions,
6. Malignant Conditions of the skin,
7. Urticaria.

Referral to the AMS shall be made if doubtexists about any condition.

Oncology

• An applicant for or holder of a Class 2 medical certificate shall have no established primary or secondary malignant disease likely to the applicable licence(s).
• After treatment for malignant disease applicants may be assessed as fit.

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