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European Union Aviation Safety AgencyAcceptable Means of Compliance (AMC)andGuidance Material (GM)to Part-MEDMedical requirements for air crewIssue 228 January 201911For the date of entry into force of this issue, kindly refer to Decision 2019/002/R in the Official Publication of theAgency.Page 1 of 113
Annex I to ED Decision 2019/002/RTABLE OF CONTENTSSUBPART A8General requirements . 8Section 1 General . 8AMC1 MED.A.015 Medical confidentiality . 8GM1 MED.A.020 Decrease in medical fitness . 8MEDICATION — GUIDANCE FOR PILOTS AND CABIN CREW MEMBERS . 8AMC1 MED.A.025 Obligations of the AeMC, AME, GMP and OHMP . 11GM1 MED.A.025 Obligations of the AeMC, AME, GMP and OHMP . 11GUIDELINES FOR THE AeMC, AME OR GMP CONDUCTING THE MEDICAL EXAMINATIONSAND ASSESSMENTS FOR MEDICAL CERTIFICATION OF PILOTS . 11Section 2 Requirements for medical certificates . 13AMC1 MED.A.030 Medical certificates . 13AMC1 MED.A.035 Application for a medical certificate . 13SUBPART B13Requirements for pilot medical certificates . 13AMC for pilot medical certificates . 13Section 1 General . 13AMC1 MED.B.001 Limitations to medical certificates . 13GENERAL. 13AMC2 MED.B.001 Limitations to medical certificates . 15LIMITATION CODES . 15Section 2a Medical requirements for class 1 medical certificates . 18AMC1 MED.B.010 Cardiovascular system. 18GM1 MED.B.010 Cardiovascular system . 26GM2 MED.B.010 Cardiovascular system . 26AMC1 MED.B.015 Respiratory system. 26AMC1 MED.B.020 Digestive system . 28AMC1 MED.B.025 Metabolic and endocrine systems . 28AMC1 MED.B.030 Haematology . 29AMC1 MED.B.035 Genitourinary system . 31AMC1 MED.B.040 Infectious disease . 32AMC1 MED.B.045 Obstetrics and gynaecology . 32AMC1 MED.B.050 Musculoskeletal system . 33AMC1 MED.B.055 Mental health . 33GM1 MED.B.055 Mental health . 36Page 2 of 113
Annex I to ED Decision 2019/002/RGM2 MED.B.055 Mental health . 37AMC1 MED.B.065 Neurology . 37AMC1 MED.B.070 Visual system. 38GM1 MED.B.070 Visual system. 42GM2 MED.B.070 Visual system. 42AMC1 MED.B.075 Colour vision. 42AMC1 MED.B.080 Otorhinolaryngology (ENT) . 43GM1 MED.B.080 Otorhinolaryngology (ENT) . 44AMC1 MED.B.085 Dermatology. 44AMC1 MED.B.090 Oncology . 45Section 2b Medical requirements for class 2 medical certificates . 46AMC2 MED.B.010 Cardiovascular system. 46GM3 MED.B.010 Cardiovascular system . 53GM4 MED.B.010 Cardiovascular system . 53GM5 MED.B.010 Cardiovascular system . 53AMC2 MED.B.015 Respiratory system. 53AMC2 MED.B.020 Digestive system . 54AMC2 MED.B.025 Metabolic and endocrine systems . 55AMC2 MED.B.030 Haematology . 56AMC2 MED.B.035 Genitourinary system . 57AMC2 MED.B.040 Infectious disease . 58AMC2 MED.B.045 Obstetrics and gynaecology . 58AMC2 MED.B.050 Musculoskeletal system . 58AMC2 MED.B.055 Mental health . 59GM3 MED.B.055 Mental health . 61GM4 MED.B.055 Mental health. 61AMC2 MED.B.065 Neurology . 62AMC2 MED.B.070 Visual system. 63AMC2 MED.B.075 Colour vision. 64AMC2 MED.B.080 Otorhinolaryngology (ENT) . 64GM2 MED.B.080 Otorhinolaryngology (ENT) . 66AMC2 MED.B.085 Dermatology. 66AMC2 MED.B.090 Oncology . 66Section 3 Specific requirements for LAPL medical certificates . 67AMC1 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 67Page 3 of 113
Annex I to ED Decision 2019/002/RAMC2 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 67CARDIOVASCULAR SYSTEM . 67AMC3 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 69RESPIRATORY SYSTEM . 69AMC4 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 70DIGESTIVE SYSTEM . 70AMC5 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 70METABOLIC AND ENDOCRINE SYSTEMS . 70GM1 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 72DIABETES MELLITUS TYPE 2 TREATED WITH INSULIN — GENERAL . 72GM2 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 73DIABETES MELLITUS TYPE 2 TREATED WITH INSULIN — CONVERSION TABLE FOR HbA1c IN %AND MMOL/MOL . 73AMC6 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 73HAEMATOLOGY . 73AMC7 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 74GENITOURINARY SYSTEM. 74AMC8 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 74INFECTIOUS DISEASE . 74AMC9 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 74OBSTETRICS AND GYNAECOLOGY . 74AMC10 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 74MUSCULOSKELETAL SYSTEM . 74AMC11 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 74MENTAL HEALTH . 74GM3 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 75MOOD DISORDER . 75Page 4 of 113
Annex I to ED Decision 2019/002/RAMC12 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 76NEUROLOGY . 76AMC13 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 77VISUAL SYSTEM . 77AMC14 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 78COLOUR VISION . 78AMC15 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 78OTORHINOLARYNGOLOGY (ENT) . 78AMC16 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 78DERMATOLOGY . 78AMC17 MED.B.095 Medical examination and assessment of applicants for LAPL medicalcertificates . 79ONCOLOGY . 79SUBPART C80Requirements for medical fitness of cabin crew . 80Section 1 General requirements . 80AMC1 MED.C.005 Aero-medical assessments . 80Section 2 Requirements for aero-medical assessment of cabin crew . 81AMC1 MED.C.025 Content of aero-medical assessments . 81GM1 MED.C.025 Content of aero-medical assessments . 81AMC2 MED.C.025 Content of aero-medical assessments . 83CARDIOVASCULAR SYSTEM . 83AMC3 MED.C.025 Content of aero-medical assessments . 85RESPIRATORY SYSTEM . 85AMC4 MED.C.025 Content of aero-medical assessments . 85DIGESTIVE SYSTEM . 85AMC5 MED.C.025 Content of aero-medical assessments . 86METABOLIC AND ENDOCRINE SYSTEMS . 86GM2 MED.C.025 Content of aero-medical assessments . 86DIABETES MELLITUS TREATED WITH INSULIN. 86AMC6 MED.C.025 Content of aero-medical assessments . 86HAEMATOLOGY . 86AMC7 MED.C.025 Content of aero-medical assessments . 87Page 5 of 113
Annex I to ED Decision 2019/002/RGENITOURINARY SYSTEM. 87AMC8 MED.C.025 Content of aero-medical assessments . 87INFECTIOUS DISEASE . 87AMC9 MED.C.025 Content of aero-medical assessments . 87OBSTETRICS AND GYNAECOLOGY . 87AMC10 MED.C.025 Content of aero-medical assessments . 88MUSCULOSKELETAL SYSTEM . 88AMC11 MED.C.025 Content of aero-medical assessments . 88MENTAL HEALTH . 88AMC12 MED.C.025 Content of aero-medical assessments . 89NEUROLOGY . 89AMC13 MED.C.025 Content of aero-medical assessments . 89VISUAL SYSTEM . 89AMC14 MED.C.025 Content of aero-medical assessments . 90COLOUR VISION . 90GM3 MED.C.025 Content of aero-medical assessments . 90COLOUR VISION — GENERAL . 90AMC15 MED.C.025 Content of aero-medical assessments . 90OTORHINOLARYNGOLOGY (ENT) . 90GM4 MED.C.025 Content of aero-medical assessments . 91OTORHINOLARYNGOLOGY (ENT) — PURE TONE AUDIOGRAM . 91AMC16 MED.C.025 Content of aero-medical assessments . 91DERMATOLOGY . 91AMC17 MED.C.025 Content of aero-medical assessments . 91ONCOLOGY . 91Section 3 Additional requirements for applicants for, and holders of, a cabin crewattestation . 92AMC1 MED.C.030 Cabin crew medical report . 92GM1 MED.C.030(b) Cabin crew medical report . 93AMC1 MED.C.035 Limitations . 95SUBPART D96Aero-medical examiners, general medical practitioners, occupational health medicalpractitioners . 96Section 1 Aero-medical examiners (AMEs) . 96AMC1 MED.D.020 Training courses in aviation medicine . 96BASIC TRAINING COURSE . 96Page 6 of 113
Annex I to ED Decision 2019/002/RGM1 MED.D.020 Training courses in aviation medicine . 97AMC2 MED.D.020 Training courses in aviation medicine . 106ADVANCED TRAINING COURSE . 106GM2 MED.D.020 Training courses in aviation medicine . 106GM3 MED.D.020 Training courses in aviation medicine . 110GENERAL. 110AMC1 MED.D.030 Validity of AME certificates. 111REFRESHER TRAINING . 111GM1 MED.D.030 Validity of AME certificates. 112GM2 MED.D.030 Validity of AME certificates. 113AME PEER SUPPORT GROUPS . 113Page 7 of 113
Annex I to ED Decision 2019/002/RSUBPART AGeneral requirementsSection 1GeneralAMC1 MED.A.015 Medical confidentialityTo ensure medical confidentiality, all medical reports and records should be securely held withaccessibility restricted to personnel authorised by the medical assessor or, where applicable, by thehead of the aero-medical centre (AEMC), the aero-medical examiner(AME), general medicalpractitioner (GMP) or occupational health medical practitioner (OHMP).GM1 MED.A.020 Decrease in medical fitnessMEDICATION — GUIDANCE FOR PILOTS AND CABIN CREW MEMBERS(a)Any medication can cause side effects, some of which may impair the safe performance of flyingduties. Equally, symptoms of colds, sore throats, diarrhoea and other abdominal upsets maycause little or no problem whilst on the ground but may distract the pilot or cabin crew memberand degrade their performance whilst on duty. The in-flight environment may also increase theseverity of symptoms which may only be minor whilst on the ground. Therefore, one issue withmedication and flying is the underlying condition and, in addition, the symptoms may becompounded by the side effects of the medication prescribed or bought over the counter fortreatment. This guidance material provides some help to pilots and cabin crew in decidingwhether expert aero-medical advice by an AME, AeMC, GMP, OHMP or medical assessor isneeded.(b)Before taking any medication and acting as a pilot or cabin crew member, the following threebasic questions should be satisfactorily answered:(1)Do I feel fit to fly?(2)Do I really need to take medication at all?(3)Have I given this particular medication a personal trial on the ground to ensure that it willnot have any adverse effects on my ability to fly?(c)Confirming the absence of adverse effects may well need expert aero-medical advice.(d)The following are some widely used medicines with a description of their compatibility withflying duties:(1)Antibiotics. Antibiotics may have short-term or delayed side effects which can affect pilotor cabin crew performance. More significantly, however, their use usually indicates thatan infection is present and, thus, the effects of this infection may mean that a pilot orcabin crew member is not fit to fly and should obtain expert aero-medical advice.(2)Anti-malaria drugs. The decision on the need for anti-malaria drugs depends on thegeographical areas to be visited, and the risk that the pilot or cabin crew member has ofbeing exposed to mosquitoes and of developing malaria. An expert medical opinionPage 8 of 113
Annex I to ED Decision 2019/002/Rshould be obtained to establish whether anti-malaria drugs are needed and what kind ofdrugs should be used. Most of the anti-malaria drugs (atovaquone plus proguanil,chloroquine, doxycycline) are compatible with flying duties. However, adverse effectsassociated with mefloquine include insomnia, strange dreams, mood changes, nausea,diarrhoea and headaches. In addition, mefloquine may cause spatial disorientation andlack of fine coordination and is, therefore, not compatible with flying duties.(3)Antihistamines. Antihistamines can cause drowsiness. They are widely used in ‘cold cures’and in treatment of hay fever, asthma and allergic rashes. They may be in tablet form ora constituent of nose drops or sprays. In many cases, the condition itself may precludeflying, so that, if treatment is necessary, expert aero-medical advice should be sought sothat so-called non-sedative antihistamines, which do not degrade human performance,can be prescribed.(4)Cough medicines. Antitussives often contain codeine, dextromethorfan or pseudoephedrine which are not compatible with flying duties. However, mucolytic agents (e.g.carbocysteine) are well-tolerated and are compatible with flying duties.(5)Decongestants. Nasal decongestants with no effect on alertness may be compatible withflying duties. However, as the underlying condition requiring the use of decongestantsmay be incompatible with flying duties, expert aero-medical advice should be sought. Forexample, oedema of the mucosal membranes causes difficulties in equalising thepressure in the ears or sinuses.(6)Nasal corticosteroids are commonly used to treat hay fever, and they are compatible withflying duties.(7)(i) Common pain killers and antifebrile drugs. Non-Steroidal Anti-Inflammatory Drugs(NSAIDs) and paracetamol, commonly used to treat pain, fever or headaches, may becompatible with flying duties. However, the pilot or cabin crew member should giveaffirmative answers to the three basic questions listed in (b) before using the medicationand carrying out flying duties.(ii) Strong analgesics. The more potent analgesics including codeine are opiatederivatives, and may produce a significant decrement in human performance and,therefore, are not compatible with flying duties.(8)Anti-ulcer medicines. Gastric secretion inhibitors such as H2 antagonists (e.g. ranitidine,cimetidine) or proton pump inhibitors (e.g. omeprazole) may be acceptable afterdiagnosis of the pathological condition. It is important to seek for the medical diagnosisand not to only treat the dyspeptic symptoms.(9)Anti-diarrhoeal drugs. Loperamide is one of the more common anti-diarrhoeal drugs andis usually safe to take whilst flying. However, the diarrhoea itself often makes the pilotand cabin crew member unfit for flying duties.(10) Hormonal contraceptives and hormone replacement therapy usually have no adverseeffects and are compatible with flying duties.Page 9 of 113
Annex I to ED Decision 2019/002/R(11) Erectile dysfunction medication. This medication may cause disturbances in colour visionand dizziness. There should be at least 6 hours between taking sildenafil and flying duty;and 36 hours between taking vardenafil or tadalafil and flying duty.(12) Smoking cessation. Nicotine replacement therapy may be acceptable. However, othermedication affecting the central nervous system (buproprion, varenicline) is notacceptable for pilots.(13) High blood pressure medication. Most anti-hypertensive drugs are compatible with flyingduties However, if the level of blood pressure is such that drug therapy is required, thepilot or cabin crew member shoul
to Part-MED Medical requirements for air crew Issue 2 28 January 2019 1 1 For the date of entry into force of this issue, kindly refer to Decision 2019/002/R in the Official Publication of the Agency. Annex I to ED Decision 2019/002/R Page 2 of 113 TABLE OF CONTENTS SUBPART A 8
