Medical Assessment- The Final go for your career take off

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4.4 CLASS-II MEDICAL ASSESSMENT ( Applicable to Cabin Crew and Airport Ground Staff). Few of the same tests are also applicable for Hotel Staff.

These requirements are applicable for initial and renewal medical examinations of Personnel holding PPL, SPL, GPL, Free Balloon Pilots, Flight Radio Telephone Operators. Ultra Light Aircraft Operators and Cabin Crew Attendants.

Once a Candidate clears all the interview rounds, these medical tests are advised and upon its clearance you become a proud employee.

4.4.1 PHYSICAL AND MENTAL REQUIREMENTS
The medical examination shall be based on the following requirements:-

(a) The applicant shall not suffer from any disease or disability which could render him or her likely to become suddenly or subtly incapacitated to the extent that the applicant is unable either to operate an aircraft safely or to perform his assigned dunes safely.

(b) The applicant shall have no established medical history or clinical diagnosis of:

(i)  a psychosis

(ii)  alcoholism

(iii)  drug dependence

(iv)  any personality disorder, particularly if severe enough to have repeatedly resulted in over-acts; or

(v)  a mental abnormality, or neurosis of a significant degree; such as might render the applicant unable to safely exercise the privileges of the licence applied for or held, unless accredited medical conclusion indicates that in special circumstances, the applicant’s failure to meet the requirement is such that exercise of the privileges of the licence applied for is not likely to jeopardize flight safety. Such that exercise of the privileges of the licence applied for is not likely to jeopardize flight safety.

(c) The applicant should have no established medical history or clinical diagnosis of any mental abnormality, personality disorder of neurosis which, according to accredited medical conclusion, makes it likely that within two years of the examination, the applicant will be unable to safely exercise the privileges of the licence or rating applied for or held.

(d) A history of acute toxic psychosis need not be regarded as disqualifying provided that the applicant has suffered no permanent impairment.

4.4.2 EXAMINATION OF NERVOUS SYSTEM

The applicant shall have no established medical history or clinical of any of the following–

(a) A progressive or non-progressive disease of the nervous system, the effects of which according to accredited medical conclusion are likely to interfere with the safe exercise of the applicant’s licence and rating privileges;

(b) Epilepsy;or

(c) Any disturbance of consciousness without satisfactory medical explanation of the cause and which may recur.

4.4.3 INJURIES TO THE HEAD

Cases of head injury and neurological procedures, the effects of which, according to accredited medical conclusion, are likely to interfere with the safe exercise of the applicant’s licence and rating privileges shall be assessed as unfit.

4.4.4 GENERAL SURGICAL EXAMINATION

The applicant shall neither suffer from any wound/injury nor have undergone any operation, nor possess any abnormality, congenital or acquired, which is likely to interfere with the safe operation of an aircraft, or with the safe performance of his duties and privileges of his licence:-

(a) The applicant shall be required to be completely free from those hernias that might give rise to incapacitating symptoms during flights.

(b) The applicant shall he free from any residual effects of general vascular and orthopedic surgeries.

(c) The applicant shall not use any implants, prosthesis which are likely to interfere with safe operations of aircraft or with the safe performance of his licence privileges

4.4.5 LOCOMOTOR SYSTEM

Any active disease of the bones, joints, muscles or tendons and all serious functional sequelae of the congenital or acquired disease shall be assessed as unfit. On issue or renewal of a licence, functional after effects of lesions affecting the bones, joints, muscles or tendons and certain anatomical defects compatible with the safe exercise of the applicant’s licence and rating privileges may be assessed as fit.

4.4.6 DIGESTIVE AND METABOLIC DISORDERS

(a) Any sequelae of disease or surgical intervention of any part of digestive tract and its adnexae, likely to cause incapacity in flight, particularly any obstructions due to stricture or compression shall be assessed as unfit.

(b) An applicant who has undergone a major surgical operation on the billiard passages or the digestive tract or its adnexae. which has involved a total or partial excision of a diversion of any of these organs should be assessed as unfit until such time as the

(c) Chief of Aviation Medicine, Civil Aviation Authority having access to the details of the operation procedures undertaken, considers that the effects of Such operation are not likely to cause his incapacity in the flight

(d) Cases of disabling disease with important impairment of function of gastro-intestinal tract or its adnexae shall be assessed as unfit. Cases of metabolic, nutritional or endocrine disorders likely to interfere with the safe exercise of the applicants licence and rating privileges shall be assessed as unfit,

(e) Proven cases of Diabetes mellitus shown to be satisfactorily controlled. without the use of any anti diabetic drug, may be assessed as fit The use of anti-diabetic drugs for the control of diabetes is disqualifying except for those oral drugs administered under conditions permitted by accredited medical conclusion which are compatible with the safe exercise of applicant’s licence and rating privileges Blood sugar testing shall form part of the medical examination for initial issue of licence shall be included in the re-examinations at the age of 40 and subsequently at 02 yearly intervals, if indicated Glycosolated Hemoglobin test may be carried-out in suspected cases or as and when clinically indicated.

4.4.7 URINARY SYSTEM

(a) Any sequelae of disease or surgical procedures on the kidneys and the urinary tract likely to cause incapacity, in particular any obstructions due to stricture or compression in general shall be assessed as unfit Compensated nephrectomy without hypertension or uremia may be assessed as fit after obtaining accredited medical opinion

(b) An applicant who has undergone a major surgical operation on the urinary system, which has involved a total or partial excision or a diversion of any of its organs shall be assessed as unfit until

such time as the Chief of Aviation Medicine, Civil Aviation Authority having access to the details of the operation performed, considers that the effects of such operation are not likely to cause any incapacity in the fligh.

(c) Cases presenting any signs of organic disease of kidneys shall be assessed as unfit, those due to transient condition may be assessed temporarily unfit till cleared by CAMB The urine shall contain no abnormal element considered by the AME / CAMB to be of pathological significance, Cases of affections of urinary passages and of genital organs shall be assessed as unfit. those due to transient condition may be assessed as temporary unfit for which accredited medical opinion will be required.

(d) An applicant for the first issue of licence who has a personal history of syphilis shall be required to furnish evidence, satisfactory to the CAMB, that the applicant has undergone adequate treatment and is likely to be cleared within next 02 years.

(e) An applicant showing any clinical signs of active syphilis should be assessed as temporarily unfit for a period of not less than three months from the date of the medical examination. At the end of the three months period, provided the applicant furnished proof, satisfactory to the medical examiner, that the applicant has undergone adequate treatment in the interim and that the serological reaction for syphilis is negative, the applicant may be assessed as fit, but where a licence is issued or renewed in these circumstances it should be valid only for a period of three months in the first instance Thereafter, provided serological reactions for syphilis to be negative the validity of the licence should be restricted to consecutive periods of three months, When the applicant has been under observation under this scheme for a total period of at least three years and the serological reactions have continued to be negative, the restrictions on the period of validity of the licence may be removed. In case where the serological reaction for syphilis remains persistently positive, examinations of the cerebrospinal fluid at the end of each period of six months, with negative results, may be accepted in lieu of negative serological reactions at the end of each period of three months.

4.4.8 GYNECOLOGICAL EXAMINATION

(a) Applicants who have a history of severe menstrual disturbances that have proved unamenable to treatment and that are likely to interfere with the safe exercise of the applicant’s licence and rating privileges shall be assessed as unfit.

(b) Applicants who have undergone gynecological operations should be considered individually on case to case basis

(c) Pregnancy shall be a cause of temporary unfitness. However in the absence of significant abnormalities, accredited medical opinion may indicate fitness during the middle months of pregnancy. Following confinement or termination of pregnancy, the applicant shall not be permitted to exercise the privileges of her licence until she has undergone re-examination and has been assessed as fit by the competent authority.

4.4.9 CARDIOVASCULAR SYSTEM

(a) The applicant shall not possess any abnormality of the heart, congenital or acquired, which is likely to interfere with the safe exercise of the applicant’s licence and rating privileges. A history of proven myocardial infarction shall be disqualifying. Suspected cases of ischaemic heart disease and CAD shall be investigated and assessed as per criteria laid-down in the subsequent paragraphs. Such commonly occurring conditions as respiratory arrhythmia, occasional extrasystoles which disappear on exercise, increase of pulse rate from excitement or exercise, or a slow pulse not associated with auriculoventricular dissociation may be regarded as being within ‘Normal’ limits. Cases of treated myocardial infarction, coronary angioplasty and CASGS shall be assessed according to the criteria laid-down in the appendice.

(b) Electrocardiography shall form part of the heart examination for the first issue of a licence and shall be included in re- examinations of applicants after the age of 30 and thereafter, no less frequently than every 05 years, and in re-examinations of all doubtful cases when clinically indicated.

(c) The systolic and diastolic blood pressures shall be within normal limits. The use of drugs for control of high blood pressure is disqualifying, except for those drugs, the use of which, according to accredited medical conclusion, is compatible with the safe exercise of the applicant’s licence and rating privileges.

(d) There shall be no significant functional nor structural abnormality of the circulatory tree.

4.4.5 RESPIRATORY SYSTEM

(a) There shall be no acute disability of the lungs nor any active disease of the structure of the lungs, mediastinum or pleurae. Radiography shall form a part of the medical examination in all doubtful clinical cases as and when indicated. However during initial issuance of licences, radiography shall form a part of the chest examination. Radiography shall be repeated thereafter every 02 years and when clinically indicated.

(b) Cases of pulmonary emphysema should be assessed as unfit only if the condition is causing symptoms and is likely to interfere in the safe performance of licence and rating privileges.

(c) Cases of active pulmonary tuberculosis, duly diagnosed, shall be assessed as unfit. Cases of quiescent or healed lesions which are known to be tuberculous, or, are presumably tuberculous in origin, may be assessed as fit after obtaining accredited medical opinion.

(d) However in case of doubts about the activity of a lesion, where symptoms of activity of the disease are lacking clinically, should be assessed as temporarily unfit for a period of not less than three months from the date of the medical examination. At the end of the three months period, a further radiography record should be made and compared carefully with the original. If there is no sign of extension of the disease and there are no general symptoms nor symptoms referable to the chest, the candidates may be assessed as fit for three months. Thereafter, provided there continuous to be no sign of extension of the disease as shown by radiographic examinations carried out at the end of each three months period, the validity of the licence should be restricted to consecutive periods of three months. When the candidate has been under observation under this scheme for a total period of at least two years and comparison of all the radiographic records shows no changes or only retrogression of the lesion, the lesion should be regarded as ‘quiescent’ or ‘healed’.

(e) Any extensive multilation of the chest wall with collapse of thoracic cage and sequelae or surgical procedures resulting in decreased respiratory efficacy at all altitudes shall be assessed as unfit.

4.5.1 RETICULO-ENDOTHELIAL SYSTEM

(a) Cases of severe and moderate enlargement of the spleen persistently below the costal margin shall be assessed as unfit.

(b) Cases of significant localized and generalized enlargement of the lymphatic glands and or diseases of the blood shall be assessed as unfit, except in cases where accredited medical opinion indicates that the condition is not likely to affect the safe exercise of the applicant’s licence and rating privileges. Cases due to a transient condition should be assessed as only temporarily unfit.

(c) Possession of the sickle cell trait should not be a reason for disqualification unless there is positive medical evidence to the contrary.

4.5.2 EAR EXAMINATION

There shall be:
(a) no active pathological process, acute or chronic, of the internal ear or of the middle ear;

(b) no unhealed (unclosed) perforation of the tympanic membranes. A single dry perforation need not render the applicant unfit. Licences shall not be issued or renewed in these circumstances unless the appropriate hearing requirements as specified in subsequent paras are complied with;

(c) no permanent obstruction of the Eustachian tubes; and

(d) no permanent disturbances of the vestibular apparatus. However transient conditions may be assessed as temporarily unfit.

4.5.3 NOSE, THROAT AND MOUTH EXAMINATION

(a) There shall be free nasal air entry on both sides.

(b) There shall be no serious malformation nor serious, acute or chronic affection of the buccal cavity or upper respiratory tract.

(c) Cases of Speech defects and stutteiing shall be assessed as unfit.

4.5.4 HEARING REQUIREMENTS

4.5.4.1 The medical examination shall be based on the following requirements:-

(a) The applicant, tested on a pure tone audiometer at first issue of licence, not less than once every 05 years up to the age of 40 years, and thereafter not less than once every 03 years, shall not have a hearing loss, in either ear separately, of more than 35 dB at any of the frequencies 500, 1000 or 2000 Etz, or more than 50 dB at 3000 Hz. However an applicant with a hearing loss greater than the above may be declared fit provided that:-

(i)  the applicant has a hearing performance in each ear separately equivalent to that of a normal person, against a background noise that will simulate the masking properties of flight deck noise upon speech and beacon signals; and

(ii)  the applicant has the ability to hear an average conversational voice in a quiet room, using both ears, at a distance of 02 meters (6 feel) from the examiner, with the back turned to the examiner.

(b) Alternatively, other methods providing equivalent results to those specified in para (a) above shall be used.

4.5.4.2 The use of hearing aids may be acceptable under some circumstances. If the applicant is unable to pass any of the above tests without the use of hearing aids, he/she may be tested using hearing aids. If the applicant meets the standards with the use of hearing aids, the certificate may be issued with restrictions.

4.5.5  VISUAL REQUIREMENTS
4.5.5.1 The medical examination shall be based on the following requirements:-

(a) The function of the eyes and their adnexa shall be normal. There shall be no active pathological condition, acute or chronic, nor any sequelae of surgery or trauma of the eyes or their adnexa likely to reduce proper visual functions to an extent that would interfere with the safe exercise of the applicant’s licence and rating privileges.

(b) Distant visual acuity with or without correction shall be 6/9 or better in each eye separately and binocular visual acuity shall be 616 or better. No limits apply to uncorrected visual acuity. Where this standard of visual acuity can be obtained only with correcting lenses, the applicant may be assessed as fit provided that-

(i)  Such correcting lenses are worn during the exercise of the privileges of the licence or rating applied for or held; and

(ii)  In addition, a pair of suitable correcting spectacles is kept readily available during the exercise of the privileges of the applicant’s licence.

4.5.5.2 An applicant accepted as meeting these provisions is deemed to continue to do so unless there is reason to suspect otherwise, in which case an ophthalmic report is required at the discretion of Chief of Aviation Medicine subject to conditions laid-down in this ANO. Both uncorrected and corrected visual acuity are normally measured and recorded at each re-examination conditions which indicate a need to obtain an ophthalmic report include

(i)  a substantial decrease in the uncorrected visual acuity, and

(ii)  any decrease in best corrected visual acuity, and

(iii)  the occurrence of eye disease, eye injury or eye surgery.

4.5.5.3 Applicants may use contact lenses to meet their visual requirements provided that:-

(i)  the lenses are monofocal and non-tinted.

(ii)  the lenses are well tolerated, and

(iii)  a pair of suitable correcting spectacles is kept readily available during the exercise of the licence privileges.

Note:-

Applicants who used contact lenses may not need to have their uncorrected visual acuity measured at each re-examination provided the history of their contact lenses prescription is known.

(Iv) Applicants with a large refractive error shall use contact lenses or high index spectacle lenses.

Note:-

If spectacles are used, high index lenses are needed to minimize peripheral field distortion.

4.5.5.4 Applicants whose uncorrected distant visual acuity in either eye is worse than 6160, shall be required to provide a full ophthalmic report prior to initial Medical Assessment and every Five years thereafter.
Note:-

The purpose of the required ophthalmic examination is:

(i)  to ascertain normal visual performance and

(ii)  to identify any significant pathology.