As part of its oversight role of the Civil
Aviation Authority (CAA) has set out what is considered to be
the minimum requirement of clinical examination to confirm functional ability
and screen for conditions that are likely to have an impact on flight safety.
Every doctor has their own routine for
performing a medical examination and the order in which it is listed and the
numbering corresponds to that found in the Medical Examination Form (Med 161). It is not supposed to represent the order in
which the examination should take place and this is left to the individual
doctor to decide. These standards will
be used during audit visits by the CAA Medical Department, when the auditor
wishes to observe a medical being performed.
It should be clear to the applicant that
the AME has a chaperone policy in place.
This should comply with the principles set out in the General Medical
Council’s guidance “Maintaining Boundaries”.
There is no minimum age for application for
an EASA medical certificate (Class 1, 2 or Light Aircraft Pilot’s Licence
(LAPL)). FCL.020 states the following
minimum ages for solo flight: 14 for sailplanes and balloons and 16 for
aeroplanes, helicopters and airships.
There is no statutory legislation governing consent in children
under the age of 16 years but there is clear case law. AMEs should follow the guidance on obtaining
appropriate consent in:
Consent: Patients and doctors making decisions together, General Medical
Council 2008 and
0-18 years: guidance for all doctors, General Medical Council 2007, particularly the section Making Decisions (paragraphs 22-41).
there is no legal requirement for written consent, the AME may wish to obtain
written consent from a parent or guardian before assessing and/or examining a
child under the age of 16.
The doctor (or
an appropriately trained assistant) should measure and record the height and
weight of the candidate using appropriately maintained and calibrated scales
and height measurement equipment.
The doctor (or
an appropriately trained assistant) should record the eye colour and hair colour of the candidate. It may be appropriate to ask the candidate
about their natural hair colour.
should record the blood pressure by using an acceptably maintained and
calibrated sphygmomanometer. Automatic
sphygmomanometers using an appropriate sized arm cuff are acceptable. If using a mercury or aneroid sphygmomanometer
the diastolic should be recorded as disappearance of sound (not muffling). If initial BP is elevated, several
measurements should be taken during the course of the examination. The lowest BP should be recorded in the
medical report (AME Online).
should assess the pulse rate and rhythm.
This should usually be done by formal palpation of the radial pulse.
should look in the ears with an otoscope and look in the mouth and
nostrils. The doctor should visually
inspect the head and neck, and assess any restriction to neck movements. A general inspection should be made of the
mouth to include teeth, soft palate and tonsillar beds. The doctor should usually inspect the
nostrils and make an assessment of the adequacy of nasal airways. Eustachian function should be assessed by any
appropriate method which may include simple enquiry. Palpation for thyroid lesions and
lymphadenopathy should be included.
Unless a qualified vision care specialist has done
this part of the examination and a report on an appropriate form (Med 162) is
available, distant visual acuity should be assessed at 5m or 6m using an
appropriate chart for the distance.
Uncorrected vision should be recorded for all candidates. If corrective lenses are required to meet the
standard then corrected visual acuity should also be recorded. If contact lenses are worn for flying
purposes then vision should also be tested using a spare pair of spectacles,
(but if these are not available at the time of the examination (initial only)
then this is not mandatory).
Intermediate vision should be assessed at
100cm using an appropriate chart.
Uncorrected vision should be recorded for all candidates. If corrective lenses are required to meet the
standard then corrected visual acuity should also be recorded.
Near vision should be assessed at a distance between 30 and 50 cm using an
appropriate chart. Uncorrected vision
should be recorded for all candidates. If
corrective lenses are required to meet the standard then corrected visual
acuity should also be recorded.
Note: It is good practice to record best
uncorrected performance in each of the three distances to track and predict
when visual performance is likely to fall below the standard.
Unless a vision
care specialist has done this part of the examination and a report on an
appropriate form (Med 162) is available, the doctor should observe the eyes and
surrounding structures. The doctor
should formally assess eye movements and check for diplopia, and perform a
field assessment by confrontation (or any other method used in routine
optometry practice). The doctor should
assess pupil size and reaction to light & perform fundoscopy.
should undress sufficiently to permit adequate examination, (auscultation) of
the heart and lungs and inspection and palpation of the abdomen. (Male patients should usually be bare above
the waist. Female patients should
usually retain a brassiere or vest).
should observe the precordium and look for the jugular venous pulse, palpate
the apex beat and auscultate over the cardiac valves and carotid areas. They should also observe, percuss and
auscultate over the upper, middle and lower segments of the lungs anteriorly
and posteriorly. The doctor should
palpate the peripheral foot pulses and assess for dependant oedema and varicose
should have a conversation with applicants about breast examination. Where the applicant undertakes regular
self-examination, self-reported findings may be accepted by the doctor. If breast examination is performed it should
be clear that this is with appropriate consent (see GMC Guidance “Maintaining
should usually be exposed from xiphisternum to just above the symphysis
pubis. The doctor should observe and
palpate the abdomen, to include the liver, spleen, kidneys and hernial
orifices. Percussion and auscultation
may also be appropriate.
The doctor should have a conversation
with male applicants about testicular examination. Where the applicant undertakes regular
self-examination, self-reported findings may be accepted by the doctor. If there are clinical indications for
performing genital or rectal examinations then it should be clear that this is
with appropriate consent (see GMC Guidance “Maintaining Boundaries”).
Many signs of
endocrine disorders may be detected during general observation and examination
of other systems. Examination of the
thyroid gland may be included as part of head and neck examination (see above).
should observe the applicant during the process of the examination and should
make enquiry and formally examine the range of movements of the spine or any
affected joints if the applicant appears to have any difficulty in cooperating
with the examination e.g. when walking to the examination room or whilst getting
onto or off the couch. Formal
examination of movement of the cervical and lumbar spine and shoulder joints
should be undertaken to ensure the applicant has an adequate range of movement
to perform all motor tasks related to flying/controlling.
should observe the applicant during the process of the examination (including
gait and posture) and should make enquiry and formally examine the neurological
system if the applicant appears to have any difficulty in cooperating with the
examination e.g. when walking to the examination room or whilst getting onto or
off the couch. A general enquiry should
be made during the assessment of history and examination to assess cognitive
function including memory. The doctor
should attempt to elicit upper and lower limb reflexes including plantar
response. Cranial nerve abnormalities
may be detected during other parts of the examination and targeted examination
may be indicated if there are concerns. The
doctor should ask the applicant to perform a Romberg’s Test.
assessment of the applicant’s history, the doctor should make a general enquiry
about mental health which may include mood, sleep and alcohol use. The doctor should observe the applicant
during the process of the examination and assess the mental state of the
applicant under the broad headings of appearance/ speech/ mood/ thinking/
perception/ cognition/ insight. The
doctor should also be looking out for any signs of alcohol or drug misuse.
The doctor should
document any identifying marks apparent during the examination and should
comment on any obvious and significant skin abnormalities. It is good practice to specifically look for
melanomas, especially on sun-exposed areas.
Examination for lymphadenopathy may be included in the examination of
other systems e.g. abdomen or head and neck.
should document and comment upon any obvious and significant abnormalities that
have not been covered elsewhere e.g. those related to exceptional over or under
weight, general examination findings such as clubbing or palmar erythema. This is also an opportunity to offer
appropriate health promotion advice as recommended by ICAO.
The doctor should perform the spoken voice hearing
test in a conversational voice at 2 m, testing each ear individually by asking
the candidate to digitally occlude one ear at a time. If both ears do not pass this test, then the
doctor should proceed to test both ears together. If hearing aids are worn the test should be
performed without aids, and, if not passed satisfactorily, be repeated with
hearing aids in position. The presence
of hearing aids should be documented. If
audiometry is to be performed it should similarly be undertaken with and
without hearing aids in position.
The doctor, or
an appropriately trained assistant, should test a mid stream specimen of urine
with an appropriate reagent strip. A
trace of blood or protein is considered acceptable but any other abnormality
mandates further testing/investigation.
then the haemoglobin level should be recorded.
Abnormal results are repeated once, and if the second reading is normal,
then this is acceptable. If the
measurements are below 12.0g/dl in males or 11.0g/dl in females then a formal
measurement of Full Blood Count is required and the completion of the medical
should be delayed until the result is received.
If the haemoglobin level recorded at the medical or from measuring Full
Blood Count result shows the haemoglobin is below 11.5g/dl in males or 10.5
g/dl in females then the applicant should be assessed as temporarily unfit and a report from a further
(specialist) assessment is required.
This is required at initial class 1 and the first
class 1 examination over 40 yrs of age. Otherwise
on clinical indication. The results
should form part of a cardiovascular risk assessment the results and
implications of which should be discussed with the applicant.
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