Medical European Class3

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EUROPEAN ORGANISATIONFOR THE SAFETY OF AIR NAVIGATION

EUROCONTROL

EUROPEAN AIR TRAFFIC MANAGEMENT PROGRAMME

Requirements for EuropeanClass 3 Medical Certification of

Air Traffic Controllers

Edition Number : 1.0Edition Date : 31.01.2003Status : Released IssueIntended for : EATMP Stakeholders


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Requirements for European Class 3 Medical Certification of Air Traffic Controllers

Page ii Released Issue Edition Number: 1.0

DOCUMENT CHARACTERISTICS

TITLE

Requirements for European Class 3 Medical Certificationof Air Traffic Controllers

EATMP Infocentre Reference: 021119-01

Document Identifier Edition Number: 1.0

HUM.ET1.ST08.10000-STD-02 Edition Date: 31.01.2003

Abstract

This document is a set of medical requirements in the medical certification of Air Traffic Controllers(ATCOs), which are proposed for application in ECAC

1States. The need for such requirements was

identified during the project to harmonise ATCO licensing. The document has been developed bythe Air Traffic Controller Medical Requirements Study Group (AMRSG) of the EATCHIP/EATMP2

Human Resources Team (HRT), from a rigorous review of both the International Civil AviationOrganization Class 3 (ICAO, 1988) and Joint Aviation Requirements Flight Crew Licensing 3(JAR-FCL 3) medical requirements (JAA, 1997).

1European Civil Aviation Conference

2European Air Traffic Control Harmonisation and Integration Programme, now known as the European AirTraffic Management Programme

Keywords

Aeromedical Certification Requirements Examination

Contact Person Tel Unit

N. CLINTON +32 2 729 3953 Human Factors and Manpower Unit (DIS/HUM)

STATUS, AUDIENCE AND ACCESSIBILITY

Status Intended for Accessible via

Working Draft o General Public o Intranet o

Draft o EATMP Stakeholders Extranet o

Proposed Issue o Restricted Audience o Internet (www.eurocontrol.int)

Released Issue

Printed & electronic copies of the document can be obtained fromthe EATMP Infocentre (see page iii)

ELECTRONIC SOURCE

Path: G:\Deliverables\HUM Deliverable pdf Library\

Host System Software Size

Windows_NT Microsoft Word 8.0b


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Page iv Released Issue Edition Number: 1.0

DOCUMENT CHANGE RECORD

The following table records the complete history of the successive editions of the presentdocument.

EDITIONNUMBER

EDITION DATEINFOCENTREREFERENCE

REASON FORCHANGE

PAGES AFFECTED

Issue A Dec 1999 Working Draft All

Issue B Jan 2000 Draft 1 All

Issue C Feb 2000 Draft 2 All

Issue D Mar 2000 Draft 3 All

Issue E May 2000 Draft 4 All

Issue F Apr 2001 Draft 5 All

Issue G Aug 2002 Draft 6 All

1.0 31.01.2003 021119-01 Released IssueAll (document configuration asper EATMP strategy and rules)


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Edition Number: 1.0 Released Issue Page v

CONTENTS

DOCUMENT CHARACTERISTICS.............................................................................ii

DOCUMENT APPROVAL..........................................................................................iii

DOCUMENT CHANGE RECORD..............................................................................iv

FOREWORD ...............................................................................................................1

I. INTRODUCTION...................................................................................................31. General Guidance ....................................................................................................3

2. Mechanical Aids .......................................................................................................3

3. Oncology ..................................................................................................................3

4. Format of this Document ..........................................................................................4

II. EUROPEAN MEDICAL CERTIFICATION REQUIREMENTS (EMCR) ................5

EMCR(ATC) 1: General - European Class 3 Medical Certification: Examination...........5

EMCR(ATC) 2: Cardiovascular System ............................................................................6

2.1: Examination................................................................................................................6

2.2: Blood pressure............................................................................................................7

2.3: Coronary artery disease..............................................................................................8

2.4: Rhythm/conduction disturbances ..............................................................................10

2.5: General.....................................................................................................................12

EMCR(ATC) 3: Respiratory System ................................................................................15

3.1: General.....................................................................................................................15

3.2: Disorders ..................................................................................................................15

EMCR(ATC) 4: Digestive System ....................................................................................17

4.1: General.....................................................................................................................17

4.2: Disorders ..................................................................................................................17

EMCR(ATC) 5: Metabolic, Nutritional and Endocrine Diseases....................................19

EMCR(ATC) 6: Haematology ...........................................................................................19

EMCR(ATC) 7: Urinary System........................................................................................21

EMCR(ATC) 8: Sexually Transmitted Diseases and Other Infections ..........................22


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Page vi Released Issue Edition Number: 1.0

EMCR(ATC) 9: Gynaecology and Obstetrics..................................................................23

EMCR(ATC) 10: Musculoskeletal Requirements............................................................24

EMCR(ATC) 11: Psychiatric and Psychological Requirements ....................................2411.1: Psychiatric requirements.........................................................................................24

11.2: Psychological requirements ....................................................................................26

EMCR(ATC) 12: Neurological Requirements..................................................................27

EMCR(ATC) 13: Ophthalmological Requirements .........................................................28

EMCR(ATC) 14: Visual Requirements.............................................................................29

EMCR(ATC) 15: Colour Perception.................................................................................32

EMCR(ATC) 16: Otorhinolaryngological System...........................................................33

EMCR(ATC) 17: Hearing Requirements..........................................................................34

EMCR(ATC) 18: Dermatological Requirements .............................................................36

REFERENCES..........................................................................................................37

GLOSSARY ..............................................................................................................39

ABBREVIATIONS AND ACRONYMS ......................................................................41

CONTRIBUTORS......................................................................................................45

ANNEX 1: ADDITIONAL GUIDANCE MATERIAL..................................................47

ANNEX 2: DECLARATION OF NATIONAL VARIATIONS TOREQUIREMENTS ...............................................................................................49


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Edition Number: 1.0 Released Issue Page 1

FOREWORD

This document has been compiled by the Air Traffic Controller Medical Requirements StudyGroup (AMRSG) in compliance with its Terms of Reference. The AMRSG was established bythe Human Resources Team (HRT) of the European Air Traffic Control Harmonisation andIntegration Programme (EATCHIP), now known as the European Air Traffic ManagementProgramme (EATMP), at the end of 1998. Its membership comprises professionals drawnfrom the medical and Air Traffic Controller (ATCO) disciplines.

The need for such a group was identified during the project to harmonise ATCO licensing,which was contracted to the Safety Regulation Group (SRG) of the UK Civil AviationAuthority (CAA), with the assistance of the HRT Licensing Work Group (LWG). All work inthis area falls within the Human Resources Domain (HUM) of the EUROCONTROL EATMPProgramme, and is directly traceable to the European Civil Aviation Conference (ECAC)Transport Ministers Strategy for the 1990s and the more recently developed ATM Strategyfor the Years 2000+ (EATMP, 1999).

The Requirements for European Medical Certification have been developed from a rigorousreview of both the International Civil Aviation Organization (ICAO) Class 3 (1988) and JointAviation Requirements - Flight Crew Licensing 3 (JAR-FCL 3) medical requirements (JAA,1997). These requirements will be regularly audited to ensure that they remain pertinent andnecessary. They will be revised and updated as appropriate, in line with developments inaviation medicine and the Air Traffic Services (ATS) environment.

Further guidance material to assist designated licensing authorities, aeromedical authoritiesand Aeromedical Examiners (AMEs) is published separately in the current edition of theICAO (1985) Manual of Civil Aviation Medicine. Additionally, as part of JAR-FCL 3, the JointAviation Authorities (JAA) Manual of Civil Aviation Medicine (commonly known as theManual) provides an overview of pertinent medical conditions. AMEs should meet therequirements set by the Aeromedical Section (AMS) to perform the required functions and inthis respect some guidance may be foundin the JAR-FCL 3 Manual.

The EUROCONTROL Safety Regulatory Requirement for ATM Services Personnel(ESARR 5) (SRC, 2000) requires air traffic controllers and student air traffic controllers, whoare providing an air traffic control service, to hold a valid medical certificate of the appropriate

class. This document has been developed as an Acceptable Means of Compliance (AMC).

It is appreciated that legal or other circumstances within a particular State may prevent thatState from complying with a particular medical requirement. These circumstances shall beevaluated by the designated State Authority, after which the State must file a difference tothe nominated body responsible for management of this document (currently under thetemporary custodianship of the AMRSG pending further deliberation withinEUROCONTROL). Each difference will be noted in Annex 2 to this document.

From the time a State implements the Requirements for European Class 3 MedicalCertification of Air Traffic Controllers, they shall apply to all holders of, and applicants for,student ATCO and ATCO licences or certificates of competence. However, it is recognised


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Page 2 Released Issue Edition Number: 1.0

that there may be individual controllers who have a particular medical condition which wasdeemed acceptable under the previous State medical requirements, but is not acceptableunder the new scheme. In these circumstances, provided the States Designated Authority is

satisfied that the controller is able to safely exercise the privileges of his licence or certificateof competence, the previous State medical requirements may continue to apply in respect ofthe specific medical condition only and his medical certificate must be annotated accordingly.In all other respects and for any new medical condition the controller may develop after theimplementation date, the new medical requirements will apply.

In the interests of harmonisation, a continuous effort is needed among the ECAC MemberStates to minimise the number of differences from the basic requirements.


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I. INTRODUCTION

1. General Guidance

The requirements and guidance in this document cannot, on their own, besufficiently detailed to cover all possible individual situations. Of necessitymany decisions relating to the evaluation of medical fitness must be left to thejudgement and discretion of the individual designated medical examiner. Theevaluation must, therefore, be based on a medical examination conductedthroughout in accordance with the highest standards of medical practice. Dueregard must be given to the privileges granted by the licence applied for orheld by the applicant for the medical certificate and the conditions under which

the licence holder is going to exercise those privileges in carrying out assignedduties. If clinically indicated, testing additional to that described in thisdocument should be carried out under the direction of the appropriatespecialist.

It should be noted that illness and its treatment may interfere with an air trafficcontrollers ability to exercise licence privileges to the required level of safety,or preclude him or her from continuing to undertake licensed functions.Individual ATCOs should consult their Aeromedical Examiners (AMEs) foradvice regarding the likely impact of illness or medication on their fitness toprovide an air traffic control service. Where there are unresolved issues,AMEs should refer the case to the Aeromedical Section (AMS). Provision of

information relating to the medical certification status of controllers to serviceproviders is a matter for individual States. The EUROCONTROL EuropeanManual of Personnel Licensing - Air Traffic Controllers (EATMP, 2000) givesguidance on this issue.

Specialists used by the AMS to assess functionality against licensed tasks andthe working environment should have a basic understanding of the ATCOsfunction.

2. Mechanical Aids

Where mechanical and electro-mechanical aids are used by an individual tomeet the required standard for medical certification, these shall be functionallytested in the operational environment by an appropriate specialist in theequipment under test, to ensure that there is no interference. It may also benecessary for an appropriate medical specialist to assess the individual usingthe aid in the operational environment.

3. Oncology

The assessment of malignant conditions is also explained in the OncologyChapter of the JAR-FCL 3 Manual (JAA, 1997), which provides information


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regarding certification and should be consulted together with the Section inthis document specific to the affected body system.

4. Format of this Document

The layout of this documentcontains requirements which must be met in theleft-hand column, and variations to the requirements andassociated guidancein the right-hand column.

Compliance is required where the terms shall or must are employed. Theterms may and should are used to denote variations to requirements andguidance, and where a proposed course of action is recommended orsuggested, rather than mandatory.

Individual States must ensure that translation into languages other thanEnglish maintains the distinction between those areas requiring compliance(i.e. mandatory) and those areas which are merely guidance. For instance, itis permissible to use the phrase is to in place of shall, if more appropriate intranslation.


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II. EUROPEAN MEDICAL CERTIFICATION REQUIREMENTS (EMCR)

REQUIREMENTS VARIATIONS TO REQUIREMENTS, ANDGUIDANCE

EMCR(ATC) 1: General - European Class 3Medical Certification: Examination

EMCR(ATC) 1: General - European Class 3Medical Certification: Examination

1.1(a) An applicant for an air traffic controllerlicence / certificate of competence shallundergo an initial medical examination for theissue of a European Class 3 MedicalCertificate. The minimum age for issue of a

European Class 3 Medical Certificate shall beseventeen years.

1.1.1 The medical certificate validity will befrom the date of issue to the equivalent datein the month of expiry (date to date).

1.1(b) Except where otherwise stated in thissection, holders of air traffic controller licences/ certificates of competence shall have theirEuropean Class 3 Medical Certificatesrenewed or revalidatedevery two years.

1.1.2 It is recommended that when holdersof air traffic controller licences / certificatesof competence have passed their fortiethbirthday, the two-year interval specified inpara 1.1(b) should be reduced to one year.

1.1(c) The applicant for a European Class 3Medical Certificate shall provide the authorisedAME with a personally certified statement of

medical facts concerning personal, familial andhereditary history. The applicant shall be madeaware of the necessity for giving a statementthat is as complete and accurate as theapplicants knowledge permits.

1.1(d) The authorisedAME shall report to thedesignated AMS any individual case wherethere is doubt about the applicants ability tomeet any requirement. In these circumstancesthe AMS may decide whether the medicalcertificate should be issued or withheld (see

para 1.1.3).

1.1.3 A medical certificate may be issuedprovided the applicants ability to exercisethe privileges of the licence / certificate ofcompetence to the required level of safetyis unlikely to be jeopardised.

1.1(e) When the AMS is satisfied that therequirements of this section have been met, aEuropean Class 3 Medical Certificate shall beissued to the applicant.

1.1(f) The requirements to be met for therenewal of a European Class 3 MedicalCertificate are the same as those for an initialcertificate, except where otherwise specificallystated.


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EMCR(ATC) 2: Cardiovascular System EMCR(ATC) 2: Cardiovascular System

2.1: Examination 2.1: Examination

2.1(a) An applicant for or holder of aEuropean Class 3 Medical Certificate shallnot possess any abnormality of thecardiovascular system, congenital oracquired, which is likely to interfere with thesafe exercise of the privileges of theapplicable licence(s) / certificate(s) ofcompetence.

2.1(b) A standard twelve-lead restingelectrocardiogram (ECG) and report arerequired at the examination for first issue of amedical certificate, at four-yearly intervalsuntil age thirty, at two-yearly intervalsthereafter and on clinical indication (however,see para 2.1.1).

2.1.1. Para 1.1.2 recommends that holders ofATCO licences / certificates of competencewho have passed their fortieth birthdayshould have their medical certificatesrenewed/revalidated annually. An ECGshould be carried out as part of the annualexamination.

2.1(c) Exercise electrocardiography isrequired only when clinically indicated inaccordance with para 2.1.2.

2.1(d) Reporting of resting and exerciseelectrocardiograms shall be carried out byspecialists acceptable to the AMS.

2.1.2 Exercise electrocardiography, or otherappropriate cardiological testing, shall berequired:

2.1.2(a) when indicated by signs orsymptoms suggestive of cardiovasculardisease;2.1.2(b) for clarification of a restingelectrocardiogram;2.1.2(c) at the discretion of an aeromedicalspecialist acceptable to the AMS;2.1.2(d) at age 65 and then at four-yearlyintervals for European Class 3 recertification.

2.1.3(a) Where blood testing is carried out bythe State Authority, as required in para

6.1(b), estimation of serum/plasma lipids,including cholesterol, to facilitate riskassessment is at the discretion of the AMS(see para 6.1.1).

2 1.3(b) Serum lipid estimation is case findingand significant abnormalities will requireinvestigation and management under thesupervision of a specialist acceptable to theAMS.


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2.1: Examination (cont.) 2.1: Examination (cont.)

2.1.3(c) An accumulation of risk factors(smoking, family history, lipid abnormalities,hypertension, etc.) will require cardiovascularevaluation by, and management under thesupervision of, a specialist acceptable to theAMS, and where appropriate in conjunctionwith the AMC or AME.

2.1(e) At age 65 years, a European Class 3Medical Certificate holder shall be reviewed atan AMC by a cardiologist acceptable to theAMS. This review shall include exerciseelectrocardiography, or other tests that willprovide equivalent information, and shall berepeated at four-yearly intervals.

2.2: Blood pressure 2.2: Blood pressure

2.2(a) The blood pressure shall be recordedwith the technique given in para 2.2.1.

2.2(b) When the blood pressure exceeds 160mmHg systolic and/or 95 mmHg diastolicconsistently, on a minimum of threeoccasions, each separated by at least 24hours, with or without treatment, the applicantshall be assessed as unfit.

2.2.1 The systolic pressure shall be recordedat the appearance of the Korotkoff sounds

(phase I) and the diastolic pressure at theirdisappearance (phase V), or the electronicmeasurement equivalent. If the bloodpressure is raised and/or the resting heartrate is increased, further observations shouldbe made. Blood pressure readings, taken onseparate occasions, should be made in thesame fashion to ensure uniform results.

2.2(c) Treatment for the control of bloodpressure shall be compatible with the safeexercise of the privileges of the applicablelicence(s) / certificate(s) of competence (seepara 2.2.2). The initiation of drug therapyrequires a period of temporary suspension ofthe medical certificate to establish theabsence of significant side-effects.

2.2.2 Anti-hypertensive treatment shall beagreed by the AMS. Medication acceptable tothe AMS may include:2.2.2(a) non-loop diuretic agents;2.2.2(b) certain (generally hydrophilic) beta-blocking agents;2.2.2(c) Angiotensin Converting Enzyme(ACE) Inhibitors;2.2.2(d) long-acting slow-channel calciumblocking agents;2.2.2(e) angiotensin two receptor blockingagents;


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2.2: Blood pressure (cont.) 2.2: Blood pressure (cont.)

2.2.2(f) At commencement of anti-hypertensive treatment, the individual will beassessed as temporarily unfit because ofpotential side-effects, until the blood pressureis satisfactorily controlled without side-effects.

2.2(d) Applicants with symptomatichypotension shall be assessed as unfit.

2.3: Coronary artery disease 2.3: Coronary artery disease

2.3(a) An applicant with suspected coronaryartery disease shall be investigated. Anapplicant with asymptomatic, minor, coronaryartery disease may be considered fit by theAMS subject to compliance with para 2.3.1.

2.3.1 In suspected asymptomatic coronaryartery disease, exercise electrocardiographyshall be required and, if necessary, followedby scintigraphy and/or coronary angiography.

2.3(b) Applicants with symptomatic coronaryartery disease shall be assessed as unfit.

2.3(c) Applicants shall be assessed as unfitfollowing myocardial infarction. A fitassessment may be considered by the AMSsubject to compliance with para 2.3.2.

2.3.2 An asymptomatic applicant who hassatisfactorily controlled risk factors if any, andrequiring no medication for ischaemic heartpain six months after the index event(myocardial infarction) shall have completedinvestigations, demonstrating:2.3.2(a) satisfactory symptom limitedexercise ECG;2.3.2(b) left ventricular ejection fraction ofgreater than 50% without significantabnormality of wall motion and normal rightventricular function;2.3.2(c) satisfactory 24-hour ambulatoryECG recording; and2.3.2(d) coronary angiography showing lessthan 30% stenosis or other imaging testingshowing no significant reversible ischaemia inany vessel remote from the myocardialinfarction and no functional impairment ofmyocardium subtended by any such vessel.


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2.3: Coronary artery disease (cont.) 2.3: Coronary artery disease (cont.)

2.3.2(d) Follow-up investigation requiresannual cardiovascular system review,including exercise ECG or exercisescintigraphy. Coronary angiography or otherimaging testing is required no later than fiveyears after the index event, unless non-invasive tests, e.g. exercise ECG/stress echo,are impeccable.

2.3(d) Applicants demonstrating satisfactoryrecovery six months following coronary by-pass surgery or angioplasty may be assessedas fit by the AMS subject to compliance withpara 2.3.3.

2.3.3 An asymptomatic applicant havingsatisfactorily controlled risk factors and using,if necessary, Beta blockers, ACE inhibitors,Statins and aspirin, who does not need tosuppress ischaemic heart pain, may bereviewed. This review, carried out six monthsafter the index event, shall include thefollowing investigations demonstrating:2.3.3(a) satisfactory symptom limited exerciseECG into Bruce Stage 4 or equivalent;2.3.3(b) left ventricular ejection fraction of

greater than 50% without significantabnormality of wall motion and normal rightventricular ejection function;2.3.3(c) satisfactory 24-hour ambulatory ECGrecording; and2.3.3(d) post-treatment coronary angiographyshowing patent grafts with a good run off, lessthan 30% stenosis in any ungrafted majorvessel, no change in the appearance of anangioplastied vessel, and no functionalimpairment of myocardium subtended by anysuch vessel.

Follow-up investigation requires annualcardiovascular system review, includingexercise ECG or exercise scintigraphy.Coronary angiography or other imagingtesting is required no later than five yearsafter the index event, unless non-invasivetests, e.g. exercise ECG/stress echo, areimpeccable.


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2.4: Rhythm/conduction disturbances 2.4: Rhythm/conduction disturbances

2.4(a) Applicants with clinically significantdisturbance of atrial rhythm, whetherparoxysmal or established, shall be assessedas unfit pending cardiological evaluation inaccordance with para 2.4.1(a).

2.4.1(a) Any clinically significant disorder ofrhythm or conduction requires evaluation by acardiologist acceptable to the AMS. Suchevaluation may include the following, onclinical indication:(1) resting and exercise electrocardiography;(2) 24-hour ambulatory electrocardiography;(3) 2D Doppler echocardiography;(4) coronary angiography;

(5) electrophysiological investigation.

2.4(b) Applicants with asymptomatic sinusbradycardia or sinus tachycardia may beassessed as fit in the absence of significantunderlying abnormality.

2.4.1(b) One atrial or ventricular ectopiccomplex on a resting electrocardiogram mayrequire no further evaluation, provided thefrequency can be shown to be not greaterthan one per minute (for example, on anextended rhythm strip).

2.4(c) Applicants with evidence of sinoatrialdisease require cardiological assessment inaccordance with para 2.4.1.

2.4(d) Applicants with asymptomatic isolateduniform ventricular ectopic complexes neednot be assessed as unfit but frequent orcomplex forms require full cardiologicalevaluation in accordance with para 2.4.1.

2.4(e) In the absence of other abnormality,applicants with incomplete bundle branchblock or stable left axis deviation may beassessed as fit. Applicants with complete rightor left bundle branch block require

cardiological evaluation on first presentationin accordance with para 2.4.1.

2.4.1(c) Left bundle branch block is morecommonly associated with coronary arterydisease and thus requires more in-depthinvestigation, which may need to be invasive.

2.4(f) Applicants with ventricular pre-excitation, e.g. Wolf-Parkinson-Whitesyndrome, shall be assessed as unfit unlesscardiological evaluation confirms that theapplicant fulfils the requirement of para 2.4.1.

2.4.1(d) 2D Doppler echocardiography shouldshow no abnormality.

2.4.1(e) A Holter recording shall demonstrateno tendency to symptomatic or asymptomatictachy-arrhythmia.


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2.4: Rhythm/conduction disturbances(cont.)

2.4: Rhythm/conduction disturbances(cont.)

2.4(g) Applicants with an endocardialpacemaker shall be assessed as unfit unlesscardiological evaluation confirms that therequirements of para 2.4.2 can be met.

2.4.2 Applicants with an endocardialpacemaker may be considered forrecertification three months after an insertionprovided:

(1) there is no other disqualifying disorder;(2) bipolar lead systems have been used;(3) the applicant is not pace-maker

dependent, i.e. incapacitating cessation ofcardiac activity would be unlikely;(4) symptom limited exercise electro-cardiography into Bruce Stage 4 orequivalent shows no abnormality orevidence of myocardial ischaemia.Scintigraphy may be helpful in the presenceof conduction disturbance/paced complexesin the resting electrocardiogram;(5) six monthly follow-up by a cardiologistacceptable to the AMS with a pace-makercheck and Holter monitoring can be carried

out;(6) experience has shown that any failuresof pacemakers are most likely to occur inthe first three months after being fitted.Therefore, recertification should not beconsidered before this period has elapsed.It is known that certain operationalequipment may interfere with theperformance of the pacemaker. The type ofpacemaker used, therefore, shall have beentested to ensure it does not suffer frominterference in the operational environment.

Supporting data and a performancestatement to this effect must be availablefrom the supplier.


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2.5: General 2.5: General

2.5(a) Applicants with peripheral vasculardisease shall be assessed as unfit, before orafter surgery. If, however, there is no sign ofsignificant coronary artery disease, orevidence of significant atheroma elsewhere,and no functional impairment, asdemonstrated by a satisfactory exercise ECGinto Stage 4 of the Bruce protocol, orequivalent, an applicant may be assessed asfit. Applicants with aneurysm of the aorta,before or after surgery, shall be assessed asunfit. Minor venous disease shall not entailunfitness. Significant venous disease requiresindividual evaluation by the appropriatespecialist in consultation with the AMS.

2.5(b) Applicants with clinically significantabnormality of any of the heart valves shall beassessed as unfit.

2.5(c) Applicants with minor cardiac valvularabnormalities may be assessed as fit by theAMS following cardiological evaluation inaccordance with para 2.5.1(a) and (b).

2.5.1(a) Unidentified cardiac murmurs shallrequire assessment by the AMS followingevaluation by a cardiologist acceptable to theAMS. If considered significant, furtherinvestigation shall include 2D Dopplerechocardiography.

2.5.1(b) Valve Conditions

(1) Bicuspid aortic valve is acceptablewithout restriction if no other cardiac oraortic abnormality is demonstrated, butrequires review on a two-yearly basis withechocardiography.

(2) Mild aortic stenosis (less than 25mmHg differential pressure or a Dopplerflow rate of less than 2 m per second) maybe acceptable. Annual review shall berequired, with 2D Doppler echo-cardiography, by a cardiologist acceptableto the AMS.


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2.5: General (cont.) 2.5: General (cont.)

2.5.1 (b) (3) Aortic regurgitation isacceptable for unrestricted certification onlyif minor, with no evidence of volumeoverload. There shall be no demonstrableabnormality of the ascending aorta on 2DDoppler echo-cardiography. Annual reviewshall be carried out by a cardiologistacceptable to the AMS.

(4) Mitral valve disease (rheumatic mitralstenosis) is normally disqualifying. Mitralleaflet prolapse and mild mitral regurgitationmay be acceptable. Applicants with isolatedmid-systolic click may need no restriction.Applicants with uncomplicated minorregurgitation may be acceptable withregular cardiological follow-up.

(5) Applicants with evidence of volumeoverloading of the left ventricle by increased

left ventricular end-diastolic diameter shallbe assessed as unfit. Annual review by acardiologist acceptable to the AMS andassessment by the AMS is required.

2.5(d) Applicants with cardiac valvereplacement/repair shall be assessed as unfit.Favourable cases may be assessed as fit bythe AMS following cardiological evaluation inaccordance with para 2.5.1(c).

2.5.1(c) Valvular surgery

(1) Applicants with implanted mechanicalvalves shall be assessed as unfit.

(2) Applicants with tissue valves may beassessed as fit by the AMS six monthsafter surgery subject to:

(i) normal valvular and ventricularfunction as judged by 2D Dopplerechocardiography;(ii) satisfactory symptom limitedexercise electrocardiography, orequivalent;(iii) the demonstrated absence ofcoronary artery disease unless this hasbeen satisfactorily treated byre-vascularisation;


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2.5: General (cont.) 2.5: General (cont.)

2.5.1(c) (2)(iv) no cardioactive medication isrequired;(v) annual cardiological review by acardiologist acceptable to the AMSshall be required.

2.5(e) Oral anticoagulant therapy isdisqualifying. After completion of treatment,applicants may be considered fit by the AMSin accordance with para 2.5.2.

2.5.2 Following anticoagulant therapy, reviewwill be required by a cardiologist acceptableto the AMS. Subcutaneous heparin treatmentmay be acceptable subject to a satisfactoryreport from an appropriate specialistacceptable to the AMS.

2.5(f) Applicants with any abnormality of thepericardium, myocardium or endocardiumshall be assessed as unfit until completeresolution has occurred or followingcardiological evaluation in accordance withpara 2.5.3.

2.5.3 Abnormalities of the pericardium,myocardium and endocardium, primary orsecondary, shall generally be assessed asunfit until clinical resolution has taken place.Cardiovascular assessment at the discretionof a cardiologist acceptable to the AMS may

need to include 2D Dopplerechocardiography, exercise electro-cardiography, 24-hour ambulatory electro-cardiographic monitoring, myocardialscintigraphy and coronary angiography.

2.5(g) Applicants with congenital heartconditions, before or after corrective surgery,shall generally be assessed as unfit.Applicants with minor abnormalities may beassessed as fit by the AMS followingcardiological investigation in accordance with

para 2.5.4.

2.5.4 Congenital heart conditions includingthose surgically corrected, shall normally beassessed as unfit unless functionallyunimportant and no medication is required.Cardiological assessment by the AMS shallbe required. Investigations may include

Doppler echocardiography, exercise electro-cardiography and 24-hour ambulatoryelectrocardiographic monitoring. Regularcardiological review shall be required.Periodicity of review should be at thediscretion of a cardiologist acceptable to theAMS.

2.5(h) An applicant having undergone cardiactransplantation shall be assessed as unfit.


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EMCR(ATC) 3: Respiratory System EMCR(ATC) 3: Respiratory System


3.1(a) An applicant for or the holder of aEuropean Class 3 Medical Certificate shallnot possess any abnormality of therespiratory system, congenital or acquired,which is likely to interfere with the safeexercise of the privileges of the applicablelicence(s) / certificate(s) of competence.

3.1(b) Posterior/anterior chest radiography isrequired at the initial examination. It may berequired at revalidation or renewalexaminations when indicated.

3.1(c) Pulmonary function tests (see para3.1.1) are required at the initial examination.A Peak Flow Test shall be performed at firstrenewal examination after age thirty, four-yearly thereafter and when clinically indicated.Applicants with significant impairment ofpulmonary function shall be assessed as

unfit.

3.1.1 Spirometric examination is required forinitial European Class 3 examination.An FEV1/FVC ratio less than 70% shallrequire evaluation by a specialist inrespiratory disease.

3.1(d) Any significant abnormality shallrequire further evaluation by a specialist inrespiratory diseases.

3.2: Disorders 3.2: Disorders

3.2(a) Applicants with significant chronicobstructive airway disease shall be assessedas unfit. Where appropriate, applicants shouldbe referred to a specialist in respiratorydiseases for assessment.

3.2(b) Applicants with reactive airway disease(bronchial asthma) requiring medication shallbe assessed in accordance with the criteria inpara 3.2.1.

3.2.1 Applicants experiencing recurrentattacks of asthma shall be assessed as unfit.European Class 3 certification may beconsidered by the AMS if the patient has mildasthma, with acceptable pulmonary functiontests and medication compatible with the safeexecution of the functions of the licence /certificate of competence.


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3.2: Disorders (cont.) 3.2: Disorders (cont.)

3.2(c) Applicants with active inflammatorydiseases of the respiratory system shall beassessed as temporarily unfit.

3.2(d) Applicants with sarcoidosis shall beassessed as unfit (see para 3.2.2).

3.2.2 Applicants with active sarcoidosis areunfit. Certification may be considered by theAMS if the disease is:(a) fully investigated with respect to thepossibility of systemic involvement; and(b) limited to hilar lymphadenopathy and theapplicant is taking no medication.

3.2(e) Applicants with spontaneouspneumothorax shall be assessed as unfitpending full evaluation (see para 3.2.3).

3.2.3 Spontaneous pneumothorax3.2.3(a) Certification following a fullyrecovered single spontaneous pneumothoraxmay be acceptable following a period ofassessment after the event with fullrespiratory evaluation including MagneticResonance Imaging (MRI).3.2.3(b) Recertification may be considered

by the AMS if the applicant fully recovers froma single spontaneous pneumothorax after sixweeks.3.2.3(c) A recurrent spontaneous pneumo-thorax is disqualifying. Certification may beconsidered by the AMS following surgicalintervention with a satisfactory recovery.

3.2(f) Applicants requiring major chestsurgery shall be assessed as unfit followingoperation and until such time as the effects ofthe operation are no longer likely to interfere

with the safe exercise of the privileges of theapplicable licences / certificates ofcompetence (see para 3.2.4). The underlyingpathology which necessitated the surgery willneed to be considered in the recertificationprocess.

3.2.4 Pneumonectomy is disqualifying.However, recertification followingpneumonectomy or lesser chest surgery maybe considered by the AMS after satisfactory

recovery and full respiratory evaluationincluding MRI.

3.2(g) Cases of pulmonary emphysemashould be assessed as unfit only if thecondition is causing significant symptoms.


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3.2(h) Cases of active pulmonarytuberculosis, duly diagnosed, shall beassessed as unfit. Cases of quiescent orhealed lesions which are known to betuberculous, or are presumably tuberculous inorigin, may be assessed as fit.

3.2(i) Initial applicants suffering from sleepapnoea syndrome shall be assessed as unfit

(however, see para 3.2.5).

3.2.5 At renewal, applicants suffering fromsleep apnoea may be assessed as fit subject

to the extent of the symptoms, satisfactorytreatment and functional evaluation in theworking environment, in accordance with theguidance at Item 1 of Annex 1 to thisdocument.

EMCR(ATC) 4: Digestive System EMCR(ATC) 4: Digestive System


4.1 An applicant for or the holder of aEuropean Class 3 Medical Certificate shall

not possess any functional or structuraldisease of the gastro-intestinal tract or itsadnexae which is likely to interfere with thesafe exercise of the privileges of theapplicable licence(s) / certificate(s) ofcompetence.

4.2: Disorders 4.2: Disorders

4.2(a) Applicants with recurrent dyspepticdisorders requiring medication or withpancreatitis shall be assessed as unfit(however, see para 4.2.1).

4.2.1(a) Recurrent dyspepsia requiringmedication shall be investigated by internalexamination (radiologic or endoscopic).Laboratory testing should includehaemoglobin assessment and faecalexamination. Any demonstrated ulceration orsignificant inflammation requires evidence ofrecovery before revalidation or renewal by theAMS.

4.2.1(b) Certification of individuals withconditions involving pancreatitis may beconsidered by the AMS if the cause orobstruction (e.g., drug, gallstone) is removed.


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EMCR(ATC) 4: Digestive System EMCR(ATC) 4: Digestive System


4.2.1(c) Alcohol may be a cause of dyspepsiaand pancreatitis. If considered appropriate afull evaluation of its use/abuse is required.

4.2(b) Applicants exhibiting symptomaticmultiple gallstones or a single large gallstoneshall be assessed as unfit until effectivetreatment has been applied (see para 4.2.2).

4.2.2 A single large gallstone may becompatible with certification afterconsideration by the AMS. An individual withasymptomatic multiple gallstones whileawaiting assessment or treatment may beconsidered for recertification by the AMS.

4.2(c) An initial applicant who has anestablished medical history or clinicaldiagnosis of acute or chronic inflammatorybowel disease (regional ileitis, ulcerativecolitis, diverticulitis) shall be assessed as unfit(however, see para 4.2.3).

4.2.3 Recertification and initial certificationmay be considered by the AMS if there is fullremission and minimal, if any, medication isbeing taken. Regular follow-up is required.

4.2(d) An applicant with herniae that may giverise to complications leading to incapacitation

shall be assessed as unfit.

4.2(e) Any sequela of disease or surgicalintervention in any part of the digestive tractor its adnexae likely to cause incapacitation,in particular any obstruction due to stricture orcompression, shall be assessed as unfit.

4.2(f) An applicant who has undergone asurgical operation on the digestive tract or itsadnexae, involving a total or partial excisionor a diversion of any of these organs, shall be

assessed as unfit (however, see para 4.2.4).

4.2.4 Following major abdominal surgery, it isunlikely that an individual will be fit to return towork before a minimum of three months haselapsed. The AMS may consider earlier

recertification if recovery is complete, theapplicant is asymptomatic, there is a minimalrisk of secondary complication or recurrenceand the effects of the operation are no longerlikely to interfere with the safe exercise of theprivileges of the applicable licences /certificates of competence. Where the surgeryinvolved is of a minor nature, it is acceptablefor the AME to make the decision.


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EMCR(ATC) 5: Metabolic, Nutritional andEndocrine Diseases

EMCR(ATC) 5: Metabolic, Nutritional andEndocrine Diseases

5.1(a) An applicant for or the holder of aEuropean Class 3 Medical Certificate shallnot possess any functional or structuralmetabolic, nutritional or endocrine disorderwhich is likely to interfere with the safeexercise of the privileges of the applicablelicence(s) / certificate(s) of competence.

5.1(b) An applicant with metabolic, nutritional

or endocrine dysfunction shall be assessedas unfit (however, see para 5.1.1).

5.1.1. Initial certification and recertification

may be considered by the AMS if thecondition is asymptomatic, clinicallycompensated and stable with or withoutreplacement therapy, and regularly reviewedby an appropriate specialist.

5.1(c) Applicants with diabetes mellitus shallbe assessed as unfit (however, see para5.1.2 and 5.1.3).

5.1.2 Glycosuria and abnormal blood glucoselevels require investigation. Certification maybe considered by the AMS if normal glucosetolerance is demonstrated (low renalthreshold) or impaired glucose tolerancewithout diabetic pathology is fully controlled

by diet and regularly reviewed.

5.1(d) Applicants with diabetes requiringinsulin shall be assessed as unfit.

5.1(e) The use of antidiabetic medications isdisqualifying (see para 5.1.3).

5.1.3 The use of biguanides and/or alpha-glucosidase inhibitors may be acceptable, asthey do not cause hypoglycaemia.

EMCR(ATC) 6: Haematology EMCR(ATC) 6: Haematology

6.1(a) An applicant for or the holder of aEuropean Class 3 Medical Certificate shallnot possess any haematological diseasewhich is likely to interfere with the safeexercise of the privileges of the applicablelicence(s) / certificate(s) of competence.

6.1(b) Blood testing shall form part of theexamination for the initial issue of a medicalcertificate, on revalidation or renewal atfour-yearly intervals until age forty, two-yearlythereafter and on clinical indication.

6.1.1 The specific analyses to be carried outmay be determined by the AMS of eachMember State.


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EMCR(ATC) 6: Haematology (cont.) EMCR(ATC) 6: Haematology (cont.)

6.1.2 Anaemias demonstrated by reducedhaemoglobin level require investigation.Anaemia which is unamenable to treatment isdisqualifying. Certification may be consideredby the AMS in cases where the primary causehas been satisfactorily treated (e.g. irondeficiency or B12 deficiency) andhaemoglobin has stabilised (recommendedrange 11 g/dl - 17 g/dl), or where minorthalassaemia or haemoglobinopathies are

diagnosed without a history of crises andwhere full functional capability isdemonstrated.

6.1(c) An applicant with significant localisedand generalised enlargement of the lymphaticglands and of diseases of the blood shall beassessed as unfit (see para 6.1.3).

6.1.3 Lymphatic enlargement requiresinvestigation. Certification may be consideredby the AMS in cases of acute infectiousprocess which is fully recovered or Hodgkinslymphoma which has been treated and is infull remission. Due to potential long-termside-effects of specific chemotherapeuticagents, the precise regime utilised must be

taken into account.

6.1(d) An applicant with acute leukaemia shallbe assessed as unfit. Initial applicants withchronic leukaemias shall be assessed as unfit(for recertification see para 6.1.4).

6.1.4 In cases of chronic leukaemiarecertification may be considered by the AMSif diagnosed as lymphatic at stages O, I (andpossibly II) without anaemia and minimaltreatment, or hairy cell leukaemia and arestable with normal haemoglobin and platelets.Regular follow-up is required.

6.1(e) An applicant with significantenlargement of the spleen shall be assessedas unfit (see para 6.1.5).

6.1.5 Splenomegaly requires investigation.The AMS may consider certification where theenlargement is minimal, stable and noassociated pathology is demonstrable (e.g.treated chronic malaria), or if the enlargementis minimal and associated with anotheracceptable condition (e.g. Hodgkinslymphoma in remission). Splenomectomymay not preclude certification, but should beassessed on an individual basis.


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EMCR(ATC) 6: Haematology (cont.) EMCR(ATC) 6: Haematology (cont.)

6.1(f) An applicant with significantpolycythaemia shall be assessed as unfit (seepara 6.1.6). Certification may be considered bythe AMS if the condition is fully controlled andgood follow-up reports have been received.

6.1.6 Polycythaemia requires investigation.The AMS may consider certification if thecondition is stable and no associatedpathology has been demonstrated.

6.1(g) An applicant with a coagulation defectshall be assessed as unfit (see para 6.1.7 and6.1.8), as are those undergoing oralanticoagulant therapy (para 2.5(e) refers).

6.1.7 Significant coagulation defects requireinvestigation. The AMS may considercertification if there is no history of significantbleeding or clotting episodes and thehaematological data indicates that it is safe todo so.

6.1.8 Following anticoagulant therapy, reviewwill be required by an appropriate specialistacceptable to the AMS. Subcutaneousheparin treatment may be acceptable subjectto a satisfactory report.

EMCR(ATC) 7: Urinary System EMCR(ATC) 7: Urinary System

7.1(a) An applicant for or the holder of a

European Class 3 Medical Certificate shall notpossess any functional or structural disease ofthe urinary system or its adnexae which is likelyto interfere with the safe exercise of theprivileges of the applicable licence(s) /certificate(s) of competence.

7.1(b) An applicant presenting any signs oforganic disease of the kidney shall beassessed as unfit. Urinalysis shall form part ofevery medical examination. The urine shallcontain no abnormal element considered to be

of pathological significance. Particular attentionshall be paid to disease affecting the urinarypassages and the genital organs (see para7.1.1).

7.1.1 Any abnormal finding upon urinalysisrequires investigation. Investigation andanalysis shall include proteinuria, haematuriaand glycosuria.

7.1(c) An applicant presenting with urinarycalculi shall be assessed as unfit (see para7.1.2).

7.1.2 An asymptomatic calculus or a historyof renal colic requires investigation. Aftertreatment certification may be consideredwith appropriate follow-up, which is to bedecided by a specialist acceptable to theAMS. Residual calculi should be disqualifyingunless they are peripheral and parenchymal.


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EMCR(ATC) 7: Urinary System (cont.) EMCR(ATC) 7: Urinary System (cont.)

7.1(d) An applicant with any sequela ofdisease or surgical procedures on the kidneysand the urinary tract likely to causeincapacitation shall be assessed as unfit. Anapplicant with compensated nephrectomywithout hypertension or uraemia may beconsidered fit (see 7.1.3).

7.1.3 Major urological surgery is normallydisqualifying. However, the AMS mayconsider certification if the appicant iscompletely asymptomatic and there is aminimal risk of secondary complication orrecurrence.

7.1(e) An applicant who has undergone amajor surgical operation in the urinary tract or

the urinary apparatus involving a total orpartial excision or a diversion of any of itsorgans shall be assessed as unfit until suchtime as the effects of the operation are nolonger likely to cause incapacity (see para7.1.3 and 7.1.4).

7.1.4 Renal transplantation or totalcystectomy is disqualifying for initial

certification. Recertification may beconsidered by the AMS in the case of:7.1.4(a) renal transplant which is fullycompensated and tolerated with minimalimmuno-suppressive therapy after at leasttwelve months; and7.1.4(b) total cystectomy which is functioningsatisfactorily with no recurrence of primarypathology.

EMCR(ATC) 8: Sexually TransmittedDiseases and Other Infections

EMCR(ATC) 8: Sexually TransmittedDiseases and Other Infections

8.1(a) An applicant for or holder of aEuropean Class 3 Medical Certificate shallhave no established medical history or clinicaldiagnosis of any sexually transmitted diseaseor other infection which is likely to interferewith the safe exercise of the privileges of theapplicable licence(s) / certificate(s) ofcompetence.

8.1.1 Particular attention should be paid to ahistory of or clinical signs indicating:

(1) HIV positivity,(2) immune system impairment,(3) infectious hepatitis or(4) syphilis.

8.1(b) An applicant having HIV infectioninvolving symptoms of active disease such as

AIDS, AIDS Related Complex, or CentralNervous System involvement shall beassessed as unfit. However, recertification ofasymptomatic HIV positive individuals may beconsidered in accordance with para 8.1.1 to8.1.3.

8.1.2 There is no requirement for generaltesting of HIV status, but testing may be

carried out on clinical indication. Oncepositivity has been confirmed, a process ofrigorous assessment and follow-up should beintroduced to enable individuals to continueworking provided their ability to exercise theirlicensed privileges to the required level ofsafety is not impaired. Treatment must beassessed by a specialist acceptable to theAMS on an individual basis for itsappropriateness and any side-effects.Guidance relating to testing regimes is atItem 2 of Annex 1 to this document.


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EMCR(ATC) 8: Sexually Transmitted

Diseases and Other Infections (cont.)

EMCR(ATC) 8: Sexually Transmitted

Diseases and Other Infections (cont.)

8.1.3 Since sudden incapacitation by seizure,or subtle incapacitation due to cognitivedysfunction, are known manifestations of HIVdisease, thorough neurological examinationshould form part of the regular assessment ofsuch individuals.

8.1(c) A diagnosis of syphilis is notdisqualifying. However, symptoms andcomplications of the disease which impair the

safe exercise of the privileges of the licence /certificate of competence are disqualifying(see para 8.1.4).

8.1.4 Certification may be considered by theAMS in the case of those fully treated andrecovered from the primary and secondary

stages.

EMCR(ATC) 9: Gynaecology andObstetrics

EMCR(ATC) 9: Gynaecology andObstetrics

9.1(a) An applicant for or the holder of aEuropean Class 3 Medical Certificate shallnot possess any functional or structuralobstetric or gynaecological condition which is

likely to interfere with the safe exercise of theprivileges of the applicable licence(s) /certificate(s) of competence.

9.1(b) If obstetric evaluation indicates anormal pregnancy, the applicant may beassessed as fit until not later than the end ofthe 34th week of gestation.

9.1.1 The AMS, or the AME under thedirection of the AMS where appropriate,should notify the candidate and the attendingphysician in writing of any potentiallysignificant complications of pregnancy.

9.1.2 Licence privileges may be resumedupon satisfactory confirmation of full recovery

following confinement or termination ofpregnancy.

9.1(c) An applicant who has undergone amajor gynaecological operation shall beassessed as unfit (however, see para 9.1.3).

9.1.3 Major gynaecological surgery isnormally disqualifying. The AMS mayconsider recertification if the holder iscompletely asymptomatic, there is only aminimal risk of secondary complication orrecurrence and the effects of the operationare no longer likely to interfere with the safeexercise of the privileges of the licence /certificate of competence.


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EMCR(ATC) 10: MusculoskeletalRequirements

EMCR(ATC) 10: MusculoskeletalRequirements

10.1(a) An applicant for or holder of aEuropean Class 3 Medical Certificate shallnot possess any abnormality of the bones,joints, muscles and tendons, congenital oracquired which is likely to interfere with thesafe exercise of the privileges of theapplicable licence(s) / certificate(s) ofcompetence. Locomotor dysfunction,amputations, malformations, loss of function

and progressive osteoarthritic disorders willbe assessed on an individual basis.

10.1.1 Abnormal physique, including obesity,or muscular weakness may require medicalassessment (including that in the workingenvironment) as approved by the AMS.

10.1(b) A candidate suffering from severeobesity shall be assessed as unfit (see para10.1.2).

10.1.2 The AME should take into account theapplicants age and body mass index inregard to this.

10.1(c) Osteo-arthritic or muscular tendonprogressive conditions resulting in functionalupset are disqualifying.

10.1.3 Osteo-arthritic or muscular tendonprogressive conditions may be of congenitalor acquired origin. Any functional upsetshould be evaluated against its impact on theindividuals ability to operate satisfactorily in

the working environment.

10.1.4 Recertification in cases of limbdeficiency, with or without limb prosthesis,may be considered by the AMS followingsatisfactory assessment in the workingenvironment.

EMCR(ATC) 11: Psychiatric andPsychological Requirements


11.1: Psychiatric requirements 11.1: Psychiatric requirements

11.1(a) An applicant for or holder of aEuropean Class 3 Medical Certificate shallhave no established medical history or clinicaldiagnosis of any psychiatric disease ordisability, condition or disorder, acute orchronic, congenital or acquired, which is likelyto interfere with the safe exercise of theprivileges of the applicable licence(s) /certificate(s) of competence.

11.1.1 The issues raised in this section arecomplex. Some guidance may be found in thechapter on Aviation Psychiatry of theJAR FCL 3 Manual.


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11.1: Psychiatric requirements (cont.) 11.1: Psychiatric requirements (cont.)

11.1(b) Particular attention shall be paid tothe following (see para 11.1.1 to 11.1.6):

(1) psychotic symptoms;(2) mood disorders;(3) personality disorders, especially ifsevere enough to have resulted in overtacts;(4) mental abnormality and neurosis;(5) use of psychoactive drugs or othersubstances, or abuse of alcohol, with orwithout dependency.

11.1(c) An established condition includingpsychotic symptoms is disqualifying.

11.1.2 Certification may only be considered ifthe AMS can be satisfied that the originaldiagnosis was inappropriate or inaccurate, oras a result of a single toxic episode.

11.1(d) An established neurosis isdisqualifying.

11.1.3 The AMS may consider certificationafter review by a psychiatric specialist

acceptable to the AMS and after psychotropictreatment has ceased for at least threemonths.

11.1(e) A single self-destructive action orrepeated overt acts are disqualifying.

11.1.4 Certification may be considered by theAMS after full consideration of an individualcase and will require psychological orpsychiatric review.

11.1(f) Habitual abuse of alcohol and abuseof psychoactive drugs or substances with orwithout dependency is disqualifying (see para

11.1.5).

11.1.5 Certification may be considered by theAMS after a period of two years documentedsobriety or freedom from drug use.

Recertification at an earlier point may beconsidered by the AMS following:

(a) a minimum of four weeks inpatienttreatment;(b) review by a psychiatric specialistacceptable to the AMS; and(c) ongoing review including blood testingand peer reports for a period of three years.


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11.2: Psychological requirements 11.2: Psychological requirements

11.2.1 Within psychiatric management,psychological assessment may have a pivotalrole in enabling the psychiatrist to make aholistic assessment.

11.2(a) An applicant who exhibits inability tocope with stress or stress-related problems toan extent where the symptoms are likely tointerfere with an individuals ability to exercisesafely the privileges of the licence / certificateof competence shall be assessed as unfit(however, see para 11.2.2 and 11.2.3).

11.2.2 If stress-related problems, which arelikely to interfere with safe exercise of the

privileges of the individuals licence /certificate of competence, are reported orindicated, a psychological evaluation by aspecialist acceptable to be AMS may berequired.

11.2(b) An applicant for or holder of aEuropean Class 3 Medical Certificate shallhave no established psychologicaldeficiencies which are likely to interfere withthe safe exercise of the privileges of theapplicable licence(s) / certificate(s) of

competence (see para 11.2.2 to 11.2.4).

11.2.3 Coping with stress includes thefollowing:

(a) coping with high workload,(b) coping with boredom,(c) unwinding after work,(d) controlling anxiety and anger,

(e) managing critical incidents.If there are indications of a lack of skills or ofincidents relating to any of the above, theapplicant should be referred to a specialistacceptable to the AMS.

11.2(c) When a psychological evaluation isindicated, it shall be carried out by apsychologist acceptable to the AMS. Theevaluation shall be directed by a neurologistor psychiatrist, as appropriate.

11.2.4 A psychological evaluation may berequired by the AMS as part of, orcomplementary to, a specialist psychiatric orneurological examination when the AME orthe Authority receives verifiable informationfrom an identifiable source which evokes

doubts concerning the mental fitness orpersonality of a particular individual. Sourcesfor this information can be accidents orincidents, problems in training or proficiencychecks, delinquency or knowledge relevant tothe safe exercise of the privileges of theapplicable licences. In simple cases, andwhere acceptable to the AMS, thepsychologist may report directly to the AME.Decisions on certification or recertification willrequire clinical judgement from the AME.


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11.2: Psychological requirements (cont.) 11.2: Psychological requirements (cont.)

11.2.5 The psychological evaluation shouldbe broad-based and may include medicalhistory, life-event history and aptitude testing,in addition to personality tests andpsychological interview.

EMCR(ATC) 12: NeurologicalRequirements

EMCR(ATC) 12: NeurologicalRequirements

12.1(a) An applicant for or holder of aEuropean Class 3 Medical Certificate shallhave no established medical history or clinicaldiagnosis of any neurological condition whichis likely to interfere with the safe exercise ofthe privileges of the applicable licence(s) /certificate(s) of competence.

12.1.1 Any progressive disease of thenervous system is disqualifying, but minorfunctional loss associated with stable (non-progressive) disease may be acceptable afterfull evaluation by a specialist acceptable tothe AMS.

12.1(b) The following conditions aredisqualifying:

(1) progressive disease of the nervoussystem;(2) epilepsy;(3) conditions with a high propensity forcerebral dysfunction.(See guidance in this section.)

12.1.2 A diagnosis of epilepsy is disqualifying.One or more convulsive episodes after theage of five is disqualifying. However, anepisode shown after full neurologicalevaluation to have specific non-recurrentcause, such as trauma or toxin, may beacceptable.

12.1.3 An episode of benign Rolandic seizuremay be acceptable, provided it has beenclearly diagnosed, with a properlydocumented history and typical EEG result.The patient must have been free of symptoms

for ten years.12.1(c) The following may be acceptablesubject to full investigation by a specialistacceptable to the AMS:

(1) disturbance or loss of consciousness;(2) head injury.

12.1.4 Investigation by electro-encephalography is recommended, at initialor renewal examinations, when indicated bythe applicants history or on clinical grounds.

12.1.5 Paroxysmal EEG abnormalities aredisqualifying. An EEG showing a singleparoxysm may not be disqualifying if, after fullevaluation by a neurological specialist, it isfound not to be pathological.


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EMCR(ATC) 12: NeurologicalRequirements (cont.)

EMCR(ATC) 12: NeurologicalRequirements (cont.)

12.1.6 A history of one or more episodes ofdisturbed consciousness is disqualifying.Such episodes may be accepted by the AMSwhen satisfactorily explained by a non-recurrent cause and after full neurologicalevaluation.

12.1.7 Head injury involving loss ofconsciousness should be treated as in para

12.1.6 above. Head injury without loss ofconsciousness, but including skull fracture,meningeal rupture or cerebral injury, may beaccepted by the AMS after complete recoveryand full neurological evaluation which mayinclude psychological assessment.

EMCR(ATC) 13: OphthalmologicalRequirements

EMCR(ATC) 13: OphthalmologicalRequirements

13.1.1 Opthalmological specialists used by

the AMS should have a basic understandingof the functionality required by air trafficcontrollers in the exercise of the privileges oftheir licences / certificates of competence.

13.1(a) An applicant for or holder of a

European Class 3 Medical Certificate shallnot possess any abnormality of the function ofthe eyes or their adnexae or any activepathological condition, congenital or acquired,acute or chronic, or any sequela of eyesurgery (see para 13.1.2) or trauma, which islikely to interfere with the safe exercise of theprivileges of the applicable licence(s) /certificate(s) of competence.

13.1(b) An applicant who has undergonerefractive surgery shall be assessed as unfit

(however, see para 13.1.2).

13.1.2 Certification or re-certification may beconsidered by the AMS twelve months afterthe date of refractive surgery provided that:

(a) pre-operative refraction (as defined inpara 14.1(b)) was less than or equal to -5dioptres;(b) satisfactory stability of refraction has

been achieved (less than 0.75 dioptresvariation diurnally); and(c) glare and contrast sensitivity is notincreased. Measurement should becarried out by an objective test acceptableto the AMS;(d) the refractive surgery carried out didnot involve radial keratotomy.


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EMCR(ATC) 13: OphthalmologicalRequirements (cont.)

EMCR(ATC) 13: OphthalmologicalRequirements (cont.)

13.1(c) A comprehensive ophthalmologicalexamination is required at the initialexamination (see para 13.1.3).

13.1.3 At the initial examination for aEuropean Class 3 Medical Certificate acomprehensive ophthalmological examinationshall be carried out by, or under the guidanceand supervision of, a specialist in aviationophthalmology acceptable to the AMS.

13.1(d) A routine eye examination shall formpart of all revalidation or renewal

examinations (see para 13.1.4).

13.1.4 At each aeromedical revalidation orrenewal examination an assessment of the

visual fitness of the licence holder shall beperformed and the eyes shall be examinedwith regard to possible pathology. Allabnormal and doubtful cases shall be referredto a specialist in aviation ophthalmologyacceptable to the AMS.

13.1(e) A comprehensive ophthalmologicalexamination is required in conjunction withrevalidation or renewal examinations(extended examination see para 13.1.4) atthe following intervals:

(1) once every four years until age forty,(2) once every two years thereafter.

13.1.5 Extended examination: at thefrequency stipulated in para 13.1(d), therevalidation or renewal examination shallinclude a comprehensive ophthalmologicalexamination carried out by, or under the

guidance and supervision of, a specialist inaviation ophthalmology acceptable to theAMS.

EMCR(ATC) 14: Visual Requirements EMCR(ATC) 14: Visual Requirements

14.1(a) Distant visual acuity, after correction ifnecessary, shall be 7/10 (6/9) or better ineach eye separately using Snellen charts (orequivalent) under appropriate illumination andbinocular visual acuity shall be 10/10 (6/6) or

better (see para 14.1(i) below).

14.1.1 Where clinical evidence suggests thatSnellen may not be appropriate, Landolt Cmay be used for assessment of visual acuity.

14.1(b) Refractive errors. Refractive error isdefined as the deviation from emmetropiameasured in dioptres. Refraction shall bemeasured by standard methods (see para14.1.2). Applicants shall be considered fit withrespect to refractive errors if they meet therequirements in the paras below.

14.1.2 Refraction of the eye shall be the indexfor assessment.


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EMCR(ATC) 14: Visual Requirements(cont.)


14.1(c) At initial entry, refraction must notexceed +3.0/-5.0 dioptres (ESE).

14.1.3 For recertification, up to - 6 dioptresmay be acceptable, provided that:

(1) no significant pathology can bedemonstrated;(2) optimal correction has been considered(contact lenses).

14.1(d) In an applicant with a refractive errorwith an astigmatic component, the

astigmatism shall not exceed 3.0 dioptres.

14.1(e) The difference in refractive errorbetween the two eyes (anisometropia) shallnot exceed 2.0 dioptres.

14.1(f) The progress of presbyopia must bechecked at every revalidation or renewalexamination. The candidate must be capableof reading the Parinaud 2 chart, N5 (orequivalent) at 30-50 cm and the Parinaud 6chart, N14 (or equivalent) at 100 cm distance,

if necessary with the aid of correction (seepara 14.1(i) below).

14.1(g) An initial applicant with functionallysignificant defects of binocular vision, asdetermined by an ophthalmologist with regardto the working environment, shall beassessed as unfit (see para 14.1.4).

14.1.4 Central vision in one eye below thelimits stated in EMCR(ATC) 14 may beconsidered for European Class 3recertification if binocular visual fields arenormal and the underlying pathology isacceptable according to ophthalmicassessment by a specialist acceptable to theAMS.

14.1(h) An applicant with diplopia shall beassessed as unfit. However, there is nospecific requirement for stereopsis (see para14.1.5).

14.1.5 Phoria testing will identify significantabnormalities in the ocular muscle balance.TNO testing may be carried out if consideredappropriate. However, an abnormal result willnot necessarily be disqualifying. This isparticularly important in the case of the rapidalternator, who, while not having fullstereopsis, cannot develop diplopia.


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14.1(i) An applicant with convergence whichis not normal shall be assessed as unfit (seepara 14.1.6).

14.1.6 Convergence outside the normal rangemay be considered acceptable provided itdoes not interfere with near vision (3050 cm)and intermediate vision (100 cm) with orwithout correction.

14.1(j) At the initial examination, anycandidate having monocular vision must bedeclared unfit.

At revalidation or renewal, the candidate maybe declared fit if the ophthalmologicalexamination is satisfactory and the conditiondoes not preclude the individual from safelyexercising the privileges of his licence /certificate of competence (see para 14.1.7).

14.1.7 Testing for revalidation or renewalcertification under these circumstancesshould include functional testing within the

appropriate working environment.

14.1(k) An applicant with imbalance of theocular muscles (heterophorias) exceeding(when measured with usual correction, ifprescribed):

1.0 prism dioptre in hyperphoria at

6 metres,6.0 prism dioptres in esophoria at6 metres,8.0 prism dioptres in exophoria at6 metres, and

14.1.8 Where high myopic correction (greaterthan -5 dioptres) is needed, individuals shouldbe required to use either contact lenses orspectacles with high-index lenses in order tominimise peripheral field distortion.

1.0 prism dioptres in hyperphoria at33 cm,6.0 prism dioptres in esophoria at33 cm,10.0 prism dioptres in exophoria at33 cm

shall be assessed as unfit unless the fusionalreserves are sufficient to prevent asthenopiaand diplopia.

14.1.9 Above 10 prism dioptres in exophoria,applicants should be referred to anophthalmologist for assessment into thefusional reserve. The whole visual capacityshould be taken into account.

14.1(l) An applicant with visual fields whichare not normal shall be assessed as unfit(however, see para 14.1(j)).


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14.1(m) If a visual requirement is met onlywith the use of correction, the spectacles orcontact lenses must provide optimal visualfunction and be suitable for air traffic controlpurposes.Correcting lenses, when worn during theexercise of licensed privileges, shall permitthe holder of the licence / certificate ofcompetence to meet the visual requirements

at all distances. No more than one pair ofspectacles shall be used to meet therequirement (however, see para 14.1.10).

14.1.10 It is recommended that a spare set ofsimilarly correcting spectacles is readilyavailable when exercising the privileges of thelicence / certificate of competence.

EMCR(ATC) 15: Colour Perception EMCR(ATC) 15: Colour Perception

15.1(a) Normal colour perception is definedas the ability to pass the Ishihara test or topass Nagels anomaloscope as a normaltrichromate (see para 15.1.1).

15.1.1 The Ishihara test (24-plate version) isto be considered passed if fifteen consecutiveplates, appropriately randomised, areidentified correctly without uncertainty orhesitation (less than three seconds per plate).This must be carried out under standard

lighting conditions. For lighting conditions seethe JAA Manual of Civil Aviation Medicine.

15.1(b) An initial applicant with less thanperfect colour vision shall be classed as unfit.At revalidation or renewal, a colour safeassessment may be acceptable providedthere is no interference with the exercise ofthe licensed privileges and no underlyingpathology. Applicants who fail Ishiharas testshall be assessed as colour safe if they passextensive testing with methods acceptable to

the AMS (anomaloscopy or colour lanterns see para 15.1.2).

15.1.2 Those failing the Ishihara test shall beexamined either by:

(a) Anomaloscopy (Nagel or equivalent).This test is considered passed if the colourmatch is trichromatic and the matchingrange is four scale units or less, or, if this isnot available, by(b) Lantern testing. This test is acceptablefor renewal assessments, but not for initial

examination. It is considered passed if theapplicant passes without error a test withlanterns such as Holmes Wright, Beyne orSpectrolux. Testing should be carried out tothe appropriate standard protocol. If anydoubts exist regarding an individuals colourperception, an assessment should be madein the working environment.

15.1(c) An applicant who fails the acceptablecolour perception tests is to be consideredcolour unsafe and shall be assessed as unfit.


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EMCR(ATC) 16: OtorhinolaryngologicalSystem

EMCR(ATC) 16: OtorhinolaryngologicalSystem

16.1(a) An applicant for or holder of aEuropean Class 3 Medical Certificate shallnot possess any abnormality of the function ofthe ears, nose, sinuses or throat (includingoral cavity, teeth and larynx), or any activepathological condition, congenital or acquired,acute or chronic, or any sequela of surgeryand trauma which is likely to interfere with thesafe exercise of the privileges of the

applicable licence(s) / certificate(s) ofcompetence.

16.1.1 ENT specialists used by AMS shouldhave a basic understanding of thefunctionality required by air traffic controllersin the exercise of their licensed functions.

16.1(b) A comprehensive otorhino-laryngological (ORL) examination is requiredat the initial examination and subsequentlyonce every four years until age forty andevery two years thereafter (extendedexamination see para 16.1.2 and 16.1.3).

16.1.2 At the initial examination acomprehensive ORL examination shall becarried out by or under the guidance andsupervision of a specialist in aviationotorhinolaryngology acceptable to the AMS.

16.1(c) A routine Ear-Nose-Throat (ENT)examination shall form part of all revalidation

and renewal examinations (see guidance tothis section).

16.1.3(a) At revalidation or renewalexaminations all abnormal and doubtful cases

within the ENT region shall be referred to aspecialist in aviation otorhinolaryngologyacceptable to the AMS.

16.1.3(b) An ENT specialist, as referred toabove, may be a suitably trained AMEacceptable to the AMS.

16.1(d) An applicant with any of the followingdisorders shall be assessed as unfit:

16.1.3(c) At the intervals stated in para16.1(b) the revalidation or renewalexamination shall include a comprehensiveORL examination carried out by or under theguidance and supervision of a specialist inaviation otorhinolaryngology acceptable to theAMS.

(1) Active pathological process, acute orchronic, of the internal or middle ear.

(2) Unhealed perforation or dysfunction of thetympanic membranes (see para 16.1.4).

16.1.4 A single dry perforation of non-infectious origin and which does not interferewith the normal function of the ear may beconsidered acceptable for certification.


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EMCR(ATC) 16: OtorhinolaryngologicalSystem (cont.)

EMCR(ATC) 16: OtorhinolaryngologicalSystem (cont.)

(3) Disturbances of vestibular function (seepara 16.1.5).

(4) Significant malformation or significant,acute or chronic infection of the oral cavity orupper respiratory tract.

16.1.5 The presence of spontaneous orpositional nystagmus shall entail completevestibular evaluation by a specialistacceptable to the AMS. In such cases nosignificant abnormal caloric or rotationalvestibular responses can be accepted. Atrevalidation or renewal examinationsabnormal vestibular responses shall beassessed in their clinical context by the AMS.

(5) Significant disorder of speech or voice. 16.1.6 Where full assessment and afunctional check is needed, due regard shouldbe paid to the operating environment in whichthe licensed functions are undertaken.

16.1(e) Particular attention shall be paid tosignificant restriction of the nasal air passageon either side, or of any dysfunction of thesinuses. These should not necessarily entailunfitness provided exercise of the licensedfunction is not impaired.

16.1(f) Any speech or voice disorder thatreduces intelligibility shall be referred to aspeech specialist.

EMCR(ATC) 17: Hearing Requirements EMCR(ATC) 17: Hearing Requirements

17.1(a) Hearing shall be tested at allexaminations. The applicant shall understandcorrectly conversational speech when testedwith each ear at a distance of two metres

from and with his back turned towards theAME.

17.1(b) Hearing shall be tested with pure toneaudiometry at the initial examination and atsubsequent revalidation or renewalexaminations every four years until age fortyand every two years thereafter (see para17.1.1).

17.1.1 The pure tone audiogram shall coverat least the frequencies from 2508000 Hz.Frequency thresholds shall be determined asfollows:


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EMCR(ATC) 17: Hearing Requirements(cont.)

EMCR(ATC) 17: Hearing Requirements(cont.)

17.1.1

250 Hz 3,000 Hz500 Hz 4,000 Hz1,000 Hz 6,000 Hz2,000 Hz 8,000 Hz

Testing at frequencies at or above 4000 Hzwill aid the early diagnosis of Noise InducedHearing loss (NIH).

17.1(c) At the initial examination

Medical European Class3

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