Doc 8984-AN/895
Introductory Part
MANUAL OF CIVIL AVIATION MEDICINE
PRELIMINARY EDITION — 2008
International Civil Aviation Organization
Approved by the Secretary General
and published under his authority
INTERNATIONAL CIVIL AVIATION ORGANIZATION
ICAO Preliminary Unedited Version — October 2008
FOREWORD
In 1970, the Personnel/Training/Medical (PEL/TRG/MED) Divisional Meeting considered that
availability of suitable medical guidance material was of importance to the uniform application of the
Standards and Recommended Practices (SARPs) in Annex 1, as well as in such fast-moving fields as
accident investigation and human factors in aviation. The meeting also recommended that action be taken
to provide expert advice to the ICAO Secretariat in support of the preparation of such medical guidance
material.
In line with the Air Navigation Commission's (standing technical body of ICAO) wishes, a small Medical
Study Group was established for the purpose of assisting the Secretariat in preparing the necessary
material. The first edition of the ICAO Manual of Civil Aviation Medicine (Medical Manual), published
in 1974, was essentially the result of this work.
Inevitably, since that time, advances have been made both in medical science generally and in aviation
medicine. Assistance and advice have been provided by aviation medical specialists from many
Contracting States, and their valuable contributions have enabled a second edition of the Medical Manual
in 1985 and now this third edition to reflect those advances as they apply to civil aviation medicine in
particular. In addition, many excellent comprehensive textbooks and published studies on aviation
medicine are now available in world literature.
This edition is intended to complement existing texts by emphasizing the clinical problems encountered
in medical certification in civil aviation. It is designed for the experienced designated medical examiner
as well as for the aviation medical expert and medical assessor, to aid in the approach and management of
intricate borderline cases.
Just as the development and enforcement of standards for medical assessment of civil aviation personnel
on an international basis is fraught with difficulties, so is the compilation of a suitable current general
medical manual complicated by the heterogeneous nature of aviation medicine and by the economic
factors involved. As a necessity certain aspects have to be omitted or can only be discussed in a more
cursory manner while, in an attempt to achieve a measure of international uniformity, other more
important aspects receive particular emphasis.
The guidance material dealing with medical assessment is intended for the use of medical examiners and
medical assessors at the discretion of the Licensing Authorities. The discussion of the application of
SARPs is, however, couched in terms intended to assist the Licensing Authority in the implementation of
the medical Standards. When making a Medical Assessment, the relevant operating environment should
be borne in mind. Applicants engaged in single pilot commercial operations carrying passengers clearly
require the most careful medical evaluation in order to reduce the risk of in-flight incapacitation. Those
engaged in multicrew operations, where there has been effective incapacitation training, may be
considered less stringently. In many such cases flight safety may be adequately protected by an
operational condition or limitation applied to the licence.
When consulting the Medical Manual it should be remembered that it is intended as guidance material
only and as such has no regulatory status. Its users should, whenever in doubt, always make reference to
the text of the current edition of Annex 1 for up-to-date information on SARPs.
While Contracting States issue licences for civil aviation purposes in accordance with their national civil
aviation regulations, these regulations are normally based upon the SARPs contained in Annex 1 to the
Chicago Convention (1944), which specifies minimum standards only. Thus an individual Contracting
State may have regulations additional to those specified in Annex 1 for some reason particular to that
ICAO Preliminary Unedited Version — October 2008
State. Furthermore, the requirements published under any national regulations are the legal requirements
of that State, regardless of what may be found in Annex 1.
However, before adding national requirements over and above those of ICAO, a State should carefully
consider whether such additional requirements are likely to improve flight safety to a significant degree.
The ICAO SARPs have been written as a means of protecting flight safety and have had a consensus
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