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agreement from Contracting States, in most cases after extensive discussion involving advice and
recommendations from outstanding medical experts appointed by several Contracting States. Additional
screening measures, apart from having an adverse financial impact on the State or the aviation industry,
may not improve flight safety. Stringent national medical requirements can result in unnecessary
restrictions or premature retirement of licence holders. They may also have the consequence of licence
holders being reluctant to report illness to the medical examiner or the licensing authority, and this is
important from the flight safety viewpoint since the value of the medical examination relies to a large
extent upon an accurate medical history. Should States make demands in excess of those included in
ICAO SARPs, the goal of harmonisation across Contracting States is not achieved and the transfer of
skilled personnel from one State to another is inhibited. It encourages ‘medical tourism’ where a licence
holder, refused a licence on medical grounds in one State because of stringent medical requirements,
seeks to obtain one in another, less demanding State.
The main purpose of the Medical Manual is to assist and guide designated medical examiners, medical
assessors and Licensing Authorities in decisions relating to the medical fitness of licence applicants as
specified in Annex 1. It is, however, envisaged that the manual might also be useful to supplement
properly supervised theoretical and practical post-graduate training in aviation medicine. Thus the texts of
the manual have been edited so that it may serve also as a textbook, and a tentative outline for a
post-graduate course for prospective designated medical examiners has been included.
In this third edition of the Medical Manual, some limitation of contents has been necessary. The scope of
the material includes, particularly, guidance on those areas in which difficulties have been experienced by
Contracting States.
States are invited to assist in improving this manual by submitting comments to the Organization and by
suggesting any pertinent additional information which might usefully be included. Submissions should be
addressed to:
The Secretary General
International Civil Aviation Organization
999 University Street
Montreal, Quebec H3C 5H7
Canada
ICAO Preliminary Unedited Version — October 2008
Acknowledgements
ICAO gratefully acknowledges contributions from the following:
S. Anthony Cullen (pathology)
Mads Klokker (otorhinolaryngology)
Carsten Edmund (ophthalmology)
Marvin Lange (psychiatry)
Sally Evans (oncology)
Anker Lauridsen (gastroenterology)
Randall M. Falk (urology)
Jacques Nolin (orthopaedics)
Robert Forgie (ophthalmology)
Jeb S. Pickard (respiratory medicine and pharmacology)
Paul L. F. Giangrande (haematology)
Erik Schroeder, deceased (gynaecology and obstetrics)
John Hastings (neurology)
Ries Simons (human immunodeficiency virus)
Ewan Hutchison (human immunodeficiency virus)
Lis Andersen Torpet (forensic odontology)
Raymond V. Johnston (endocrinology)
Claus Curdt-Christiansen (editorial consultant)
Michael Joy (cardiology)
— — — — — — — —
ICAO Preliminary Unedited Version — October 2008
TABLE OF CONTENTS
PART I. LICENSING PRACTICES Page
Chapter 1. Rules concerning licences ................................................................................... I-1-1
Chapter 2. Medical requirements.......................................................................................... I-2-1
Chapter 3. Flight crew incapacitation ................................................................................... I-3-1
PART II. AVIATION PHYSIOLOGY
Chapter 1. Physiological factors of relevance to flight safety .............................................. II-1-1
PART III. MEDICAL ASSESSMENT
Chapter 1. Cardiovascular system......................................................................................... III-1-1
Chapter 2. Respiratory system.............................................................................................. III-2-1
Chapter 3. Digestive system ................................................................................................. III-3-1
Chapter 4. Metabolic, nutritional and endocrine diseases..................................................... III-4-1
Chapter 5. Haematology ....................................................................................................... III-5-1
Chapter 6. Urinary system .................................................................................................... III-6-1
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Manual of Civil Aviation Medicine 1(2)
