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they know when to seek medical help, and when to cease flying. For example, cardiac disease is
considered an important flight safety risk by all Licensing Authorities, although the importance of this
risk varies with the prevalence of such disease in different States. States should inform applicants of this
potential risk to their health and to their medical fitness. The same principle applies to certain infectious
diseases, depending on the prevalence of such infections in different regions of the world. Licensing
Authorities may wish to place more or less emphasis on this aspect of fitness for holders of licences
issued by their State.
States can provide information about relevant physical and mental conditions in many ways. Examples
include: internet website; information circular; medical examiner briefing. The most effective way(s) is
likely to differ from State to State. A medical examiner briefing may be effective, and for Class 1
applicants under 40 years of age it is suggested that this could be formally included in the preventive and
educative part of the medical assessment.
For many conditions, modern medical practice has changed the length of time required in hospital, and
some conditions, which in the past involved a lengthy hospital stay, can now be dealt with very quickly,
sometimes even on an outpatient basis. One State lists the following conditions as requiring advice from
a designated medical examiner before a return to operations can be considered:
a) any surgical operation
b) any medical investigation with abnormal results
c) any regular use of medication
d) any loss of consciousness
e) kidney stone treatment by lithotripsy
f) coronary angiography
g) transient ischaemic attack
h) abnormal heart rhythms including atrial fibrillation/flutter
In many instances of ill-health a medical practitioner without any training in aviation medicine may be
unable to provide appropriate advice to a licence holder regarding fitness to fly. Any licence holder
should be aware of the action to take in the event of suffering a common cold, without having to seek
advice from a designated medical examiner unless there are complicating factors, but for more serious
conditions advice concerning fitness to operate should be readily available from those with specialist
knowledge, e.g. a designated medical examiner or the aviation medicine section of the Licensing
Authority. If a “temporarily unfit” assessment is made, the method for regaining fitness should be clear
and, when fitness is regained, return to operations should not be unduly delayed. If a licence holder is
affected by any medical condition such as those mentioned in the list above (which is not exhaustive), he
should be aware of the need to seek aeromedical advice before again exercising the privileges of his
licence.
Use of psychoactive substances
In the context of aviation, any use of psychoactive substances, even when prescribed in accordance with
best medical practice for a medical condition and used in amounts that allow normal daily activities to be
carried out as usual, is likely to jeopardize flight safety. The term “problematic use”, which is employed
in regulatory aviation medicine, is defined in Annex 1:
Problematic use of substances. The use of one or more psychoactive substances by aviation personnel in a
way that:
a) constitutes a direct hazard to the user or endangers the lives, health or welfare of others; and/or
b) causes or worsens an occupational, social, mental or physical problem or disorder.
It is important to distinguish between the terms “under the influence of any psychoactive substance”
(1.2.7.1) and “engage in problematic use of substances” (1.2.7.2). The former relates to any person who
has recently taken a psychoactive substance (such as a glass of wine) and for that reason is temporarily
unsafe, whereas the latter relates to a person who is a habitual user of psychoactive substances and
consequently is unsafe, also between uses.
1.2.7.1 Holders of licences provided for in this Annex shall not exercise the privileges of their
licences and related ratings while under the influence of any psychoactive substance which might
render them unable to safely and properly exercise these privileges.
1.2.7.2 Holders of licences provided for in this Annex shall not engage in any problematic use of
substances.
1.2.7.3 Recommendation.— Contracting States should ensure, as far as practicable, that all licence
holders who engage in any kind of problematic use of substances are identified and removed from their
safety critical functions. Return to the safety-critical functions may be considered after successful
treatment or, in cases where no treatment is necessary, after cessation of the problematic use of
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Manual of Civil Aviation Medicine 1(12)
