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decision as to how this information will be used.
Some Contracting States have been giving increasing importance to medical facts relating to controllers and
their tasks, recognizing that technological progress has been rapid but that the controller as the final arbiter
has not changed. The controller must still make many and varied decisions, sometimes under considerable
stress, to produce a safe, orderly and expeditious flow of traffic.
SELECTION AND SUPERVISION
To carry out the job effectively, the Air Traffic Control Officer (ATCO) must meet the Standards specified
for a Class 3 Medical Assessment as laid down in Annex 1. It should be noted that the differences between
Class 1 (applicable to professional pilots) and Class 3 (applicable to ATCOs) are minimal. Medical
procedures should include a full history, including family history, and a full physical examination carried
out in accordance with 6.5 in Chapter 6 of Annex 1. Controllers are to be examined every four years until
the age of 40, then every two years (and after age 50 preferably once per year), and it is important to
exclude, so far as is possible, any cause for incapacitation during this time. A baseline 12-lead resting ECG,
and a pure tone audiogram are required at initial examination, and thereafter at intervals determined by the
age of the applicant.
The Designated Medical Examiner (DME) is responsible for determining the physical and mental fitness of
the applicant. However, the assessment of aptitude is not done by the DME and is not part of the Class 3
assessment. Research generally supports the value of psychological testing as a measure of such aptitude,
aiming at predicting adequate performance during the controller’s career, although the most appropriate
tests are subject to ongoing debate.
Subsequent loss of licence, on medical grounds, amongst active controllers appears not to be excessive
which suggests that the validity and interpretation of present medical standards are correct.
JOB-RELATED STRESS
Air traffic control has been widely perceived as being a stressful occupation. Research conducted in one
Contracting State has shown a higher incidence of stress-related illness such as hypertension and peptic
ulceration as compared with a control population. However, other reports fail to substantiate this and a more
recent study encompassing all ATCOs in a Contracting State indicates that controllers enjoy better health
than the background population and have a lower prevalence of stress-related conditions.
There is even less agreement on what is the nature of this stress, and little supporting evidence that such
stress is harmful. One study of a group of ATCOs in a Contracting State suggests that the generally
preconceived factors thought to be stressful are not necessarily so. For example, responsibility for safety
and lives was not a stressor whereas being overloaded was. High work load was not, but boredom was.
Failure of pilots or other controllers to conform to standard operating procedures was, but shift working was
ICAO Preliminary Unedited Version — October 2008 III-16-2
not. Research continues.
Stressful factors Non-stressful factors
Being overloaded Responsibility for
safety and lives
Boredom High work load
Failure to conform
by others
Shift working
In order to predict and/or prevent job-related stress interfering with performance and/or producing loss of
licence on medical grounds, the DME should attempt to establish close rapport with ATCOs. A good
occupational health programme is clearly of value and, as an example, close attention should be paid to
short-term trivial sickness absence as a good indicator for stress.
CORONARY HEART DISEASE
This is still responsible for significant loss of licence, according to figures published by some Contracting
States.
ICAO SARPs permit recertification of ATCOs who have suffered a myocardial infarction or undergone
cardiac surgery, provided the controller’s cardiac condition has been investigated and evaluated in
accordance with best medical practice and is assessed not likely to interfere with the safe exercise of his or
her licence and rating privileges.
The length of time considered necessary before the controller can be allowed back on duty after a cardiac
event might be shortened by the inclusion on the licence of an endorsement calling for a “similarly
qualified controller to be in close proximity while the licence holder is exercising the privileges of the
licence”.
PSYCHIATRIC DISORDERS
These illnesses are responsible for a significant number of ATCOs having licences withdrawn on medical
grounds, but their prevalence does not differ significantly when compared to other licence-holders. In
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Manual of Civil Aviation Medicine 2(114)
