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being a lowered efficiency and impaired performance.
In this particular connection, care should be taken by appropriate authorities to ensure that good
quality rest facilities are provided for air crew at stations away from their bases. This is an important
measure to diminish the effects of fatigue.
Several self-imposed stresses can be mentioned as contributory causes leading to fatigue: of
paramount importance in this respect are drugs, alcohol, tobacco, poor sleep hygiene, inadequate diet, and
the general state of health of the licence holder.
ICAO Preliminary Unedited Version — October 2008 II-1-19
Consideration should be given not only to the routine operational conditions, but also to those
situations when there is an increased demand for mental and physical ability to cope with emergency
situations and periods of peak workloads (e.g. missed approach, aborted take-off and, for ATC officers,
high density towers, heavy traffic).
Particular reference is made in the above considerations to results of studies showing that a fatigued
pilot can concentrate effectively enough on a principal task but has reduced ability to cope with extra
stimuli or secondary tasks which may arise.
To ensure that fatigue of licence holders does not endanger the safety of a flight, regulatory
documents specify limitations of flight time and flight duty periods (see further Part I, Chapter 1).
However, it is true to say that prevention of fatigue is an issue that requires further work by many
regulatory authorities.
FURTHER READING
DeHart, R.L., Davis, J.R. Fundamentals of Aerospace Medicine, 3rd edition. Lippencott, Williams and
Wilkins,Philadelphia, 2002
Rainford, D.J., Gradwell, D.P. eds. Ernsting’s Aviation Medicine. Hodder Arnold, London, 2006.
Roesler S et al. Calculation of radiation fields in the atmosphere and comparison to experimental data.
Radiat Res; 149: 87-97. 1998.
Schraube H et al. Experimental verification and calculation of route doses. Radiat Prot Dosim; 86: 309-
15. 1999.
UK House of Lords Select Committee on Science and Technology. Air Travel and Health:
http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldselect/ldsctech/121/12101.htm
November 2000
————————
ICAO Preliminary Unedited Version — October 2008
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Part III
MANUAL OF CIVIL AVIATION MEDICINE
PRELIMINARY EDITION — 2008
International Civil Aviation Organization
PART III. MEDICAL ASSESSMENT
Approved by the Secretary General
and published under his authority
INTERNATIONAL CIVIL AVIATION ORGANIZATION
ICAO Preliminary Unedited Version — October 2008
Part III
Chapter 1. CARDIOVASCULAR SYSTEM
Page
Introduction................................................................................................. III-1-1
History and medical examination .............................................................. III-1-5
Coronary artery disease .............................................................................. III-1-14
Rate and rhythm disturbances .................................................................... III-1-20
Atrioventricular conduction disturbances .................................................. III-1-26
Intraventricular conduction disturbances ................................................... III-1-27
Ion channelopathies ................................................................................... III-1-29
Endocardial pacemaking ............................................................................ III-1-30
Heart murmurs and valvar heart disease .................................................... III-1-31
Pericarditis, myocarditis and endocarditis ................................................. III-1-34
Cardiomyopathy ......................................................................................... III-1-36
Congenital heart disease ............................................................................ III-1-40
Diseases of the great vessels ...................................................................... III-1-43
Peripheral vascular disease ........................................................................ III-1-44
Venous thrombosis ..................................................................................... III-1-44
Syncope ...................................................................................................... III-1-45
References: ................................................................................................. III-1-48
Appendix 1a — Basic electrocardiography.......................................... III-A1a-1
Appendix 1b — Illustrative resting electrocardiograms ...................... III-A1b-1
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