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Aviation medicine – Are you fit for the pilot job?

Special attention is paid to medical prerequisites for pilots. Today, aviation medicine is a special field in its own right. Pilots must also prove their medical fitness at regular intervals.

You can only fly as a pilot if you hold a medical licence in addition to your pilot licence.

The ICAO (International Civil Aviation Organisation) provides guidelines for the fitness of pilots worldwide. Nevertheless, no institution can prescribe laws to a country. Therefore, the individual countries must convert the guidelines into national laws.

This means that there are differences from country to country in the implementation of the guidelines and always slightly different requirements for your medical apply.

Therefore, you should always contact a medical examiner in your country if you have any medical questions. He is the only one who can really help you or refer you to the appropriate specialists.

Nevertheless, I would like to give you an overview of the medical requirements so that you are better versed in this area and can ask your medical examiner specifically.

Find an medical examiner

Some countries provide you with a website where you can easily get a list of all medical examiners. Click on the link and you will get to the right page.

Australia

https://www.casa.gov.au/licences-and-certification/aviation-medicine/search-medical-examiner-or-eye-examiner/designated

United States of America

https://www.faa.gov/pilots/amelocator/

Neuseeland

https://www.caa.govt.nz/medical/amenz/

For all other countries you can find official medical examiners here.

Aeromedical requirements

Now we take a closer look at your health requirements from the point of view of aviation medicine.

Requirements for your eyes

According to the international guidelines, it would even be possible to grant a Medical if someone only sees on one eye. But you won't find much about it in national laws. You need both eyes for your medial.

Visual aids and vision

Glasses or contact lenses are not necessarily an obstacle for your medical. But you have to pass the vision test.

Vision tests

You're going through a lot of vision tests right now on your first medical. There you will test near vision, distance vision, 3D vision, the field of vision and much more.

Among other things, you must be able to recognize the correct letters on a letter board from a distance of six meters.

There are also limits to the visual impairment of distance vision. These values also vary from authority to authority. According to international guidelines, there are the following requirements:

In the case of farsightedness, the visual defect may not be more than +5 dioptres and in the case of nearsightedness not more than -6 dioptres. In addition, the difference in visual impairment between one eye and the other must not exceed 2.0 dioptres. In addition, the corneal curvature must not exceed 2.0 diopters.

If you want to apply for an Airline Pilot Training, you should read the airline requirements carefully. Many prescribe a lower visual impairment of +/-3 dioptres as maximum values. This is because the companies invest a lot of money in you when they train you. The airlines want to make sure that even if your vision deteriorates, you don't have to give up your medical right away.

Glasses and contact lenses

If you can only recognize the required letters in the particular row with glasses, you will still be considered fit in this point. But you must always wear the glasses when you are doing your job as a pilot and you must always have spare glasses ready for use. As soon as you have only one pair of glasses or contact lenses left, you are no longer allowed to carry out your job.

Almost the same rules apply to contact lenses. You must always wear them when you are a pilot. In addition, the contact lenses must be monofocal, i.e. single vision lenses, and not tinted and well tolerated. Finally, you must always have a replacement pair of the same strength and condition ready to hand during your work.

Laser surgery - Are pilots allowed to do Lasik?

Worldwide, more and more experience is being gained in eye operations. The success rate is very high. More than 95% of patients achieve a slight visual impairment after the operation for vision without glasses or contact lenses. But there are also a number of complications.

With regard to aviation, the following risks should be mentioned in particular: The improvement in vision achieved is lost over time. There are also under- or over-corrections and changes in vision throughout the day. In addition, glare, halo, starburst (exploding stars) can be observed. This is caused by corneal opacity, loss of contrast sensitivity, loss of low-contrast visual acuity, and regression to visual impairment before surgery.

Restoration of vision is most likely in PRK and LASIK surgery. In addition, normally no visible corneal scars remain.

Nevertheless, it must be emphasized that the granting of a medical certificate can only be carried out under certain conditions. You should never have an operation performed without talking to a medical examiner.

For you to get a medical or get it back, the operation must have gone without complications and your vision must remain stable. In addition, your cornea must not be cloudy and you must not have any complaints regarding glare, halos or starburst. After the operation, your eyes must be assessed by a specialist. In addition, you must have your eyes checked for changes by a specialist at regular intervals.

In summary, it must be emphasized that if you undergo eye surgery, there is a risk that you will not get your medical back until later or, if complications occur, you will lose your medical forever or never get one.

As a pilot you can always have a laser operation on your eyes. But there are risks. Therefore, discuss this with your medical examiner before you have an operation.

Colour vision impairment

A red-green visual impairment or blindness occurs quite frequently. About 9% of men and only 0.9% of women are affected.

It is very important for pilots to distinguish between red and green. Many signals in the cockpit and also outside are red or green and you have to be able to distinguish them.

Spatial vision

Spatial vision is also called stereo vision. For this you need both eyes. Each eye takes a slightly different picture, because they are slightly offset and therefore look at an object or an object at a slightly different angle. Your brain then builds a spatial image from the two images, so that you can perceive the depth.

Shortly before landing the plane on the ground you have interrupt the descent rate. In order to estimate how high you are above the ground, you need spatial vision.

This test can also be done by your optician. 

Field of vision

In addition to spatial vision, Medical also tests your field of vision. The field of vision is everything you see when you hold your head straight and look straight. On the one hand, you perceive a part very sharply, but on the other hand you can also see a lot of things blurred around you. This area also belongs to the field of vision.

A distinction is made between monocular and binocular vision. Monocular vision describes the field of vision of one eye and binocular vision describes the entire field of vision of both eyes.

Normally, humans have a field of view of 180° from right to left, 60° up and 70° down. In this test, you look into a semi-circular white sphere. Small red dots light up somewhere on the surface. If you recognize them, you press a button. The doctors can then determine where your field of vision is restricted or whether everything is ok.

This test can be used, for example, to diagnose eye diseases.

Ears - How good is your hearing?

As a pilot, you should have good hearing. Even though we have a lot of displays in the cockpit, you often hear sounds much earlier before you hear that something is wrong in the cockpit.

For example, if a seal on a door no longer seals completely, you hear a whistle. The airplane doesn't even notice this small pressure loss and is also harmless. But as a pilot you should be able to hear such unusual noises at an early stage. Because it could become a bigger problem.

The hearing test

Now, get something on your ears. In this test you get headphones on and different tones played. Tones are nothing more than vibrations, which is why the pitch is given in frequencies. These tones are very quiet at first and become louder and louder. As soon as you perceive a tone, you press a button.

0dB at one frequency means perfect hearing. The hearing impairments are then indicated in intervals of 10, 20, 30 or 40 dB.

According to the international ICAO guidelines, the following limit values are prescribed. Again, it is important to note that the national limit values may be higher or lower.

Frequencies/ maximum weakness

500 Hz/ 35 dB

1000 Hz/ 35 dB

2000 Hz/ 35 dB

3000 Hz/ 50 dB

What does that mean now?

As a reference for you, if you can hear a person from 2m at normal speech volume in both ears, you should have no problem.

If you have approached the required limit of 5 dB in a certain frequency range, you will have to go to the hearing test every year. Especially in the course of a pilot's career, certain frequency ranges can get worse.

Often it is a frequency range in which the engines can be heard in the aircraft. Since a pilot is exposed to this noise for years, it damages his hearing.

Pressure equalization

As a pilot you will always be subject to pressure fluctuations. The cabin of the aircraft will always have a different pressure. Especially during climb and descent flights you have to be able to balance the pressure.

This assumes that the eardrum has no cracks or holes and that you can equalize the pressure over the throat. There is a small tube that leads to the inner ear. The cracking in the ears is nothing else than opening this tube and balancing the pressure.

For colds

When your paranasal sinuses swell, this tube often swells and can no longer be opened. Then pressure equalization is no longer possible and you should never get on a plane. If you do it anyway, the eardrum can tear in the worst case. Then your medical is in danger. Besides, it hurts insanely.

Body size - Why size matters.

A German comedian once said: "Legs are long enough when they reach from the body to the ground". He's definitely right about that. And yet there are limits to body size. Because there is a lower limit, but there is also an upper limit. The minimum height for most airlines is 1.60 m or 1.65 m. If you are smaller, it will be difficult for you and I will explain why.

Why body size counts for pilots

A cockpit is a small space that is well utilized. All important switches and levers are distributed throughout the cockpit. If you sit on one of the two seats in the cockpit, most switches and buttons are in front of and above you. But also laterally and behind your seats. You have to get to all the buttons while sitting. Your seat can be adjusted in height, but the smaller you are, the harder it gets to get to everything. Why is that important? Imagine you are flying through an area with a lot of turbulence and suddenly there are technical problems. When you work through the checklists, you notice that you have to flip a switch that you can't reach. The colleague is busy flying the plane. That means it's your job to flip this switch.

Then why is there a maximum height?

Like I said, the cockpit is a small room. The bigger you are, the more difficult it is to get into the pilot's seat. You can also hit your head on the top. Therefore the maximum size is often 1,98 m. In general the space on an airplane is rather limited. Your health always comes first. You sit a lot in the cockpit. But too much sitting can lead to thrombosis. In a thrombosis, a blood clot forms that then blocks the bloodstream and the blood can no longer flow properly. So I get up whenever I can to move as much as possible. So it's important that you can stand upright and walk in the rest of the plane. Of course, every plane has different cabin heights. Nevertheless, from a height of 1.98 m it gets narrow in every airplane.

Body weight - What is too much or too thin?

There are also upper and lower restrictions on body weight. However, weight alone says little about whether you are airworthy or not. And yet the BMI is calculated.

Too heavy?

People with a lot of muscles will quickly fall out of the BMI table even though they are very athletic. No matter for what reason you exceed a certain BMI, you will be sent to the physiologist. He should judge how agile you are.

Too thin?

If you are very thin, the medical examiner will examine you to see whether you have enough physical reserves to survive the stressful everyday life. Because there won't always be something to eat. In an emergency situation, you may have to perform at your best with an empty stomach.

Heart diseases

If you have heart disease, I have to refer you to your medical examiner. Because here an exact diagnosis is necessary. I also know pilots with heart defects, although they have received the Medical only under certain conditions.

There are exceptions, but your heart should be healthy.

Neurology

Again, you may want to take a special test with your first Medical - the EEG. Electroencephalography makes it possible to visualize neurological processes in your brain. This allows epilepsy to be diagnosed.

As a pilot you process a lot of information in your head at the same time. So your head is strongly challenged and performs at its best. Your brain should therefore be fit. Signs of epilepsy would lead to you not getting a medical.

Diabetes

In the case of diabetes, it depends on the respective form. You may even get a medical certificate so you can work as a pilot. You owe this to advances in medicine and its treatment methods, which are constantly being improved.

According to international guidelines, it would be possible for you to get a medical if your diabetes can be controlled by tablets and diet. Once you need injections to regulate blood sugar, it becomes difficult with the Medical. Ultimately, you need to check with your aviation authority or a medical aviation professional in your country to see if you can get a Medical with your form of diabetes.

High blood pressure

It's not just about getting or keeping a medical. It is also about preventing the complications of stroke, heart attack and kidney failure caused by years of damage to the heart and blood vessels.

High blood pressure is often referred to as "the silent killer" because high blood pressure usually does not cause any symptoms at all. Therefore, you should know your blood pressure. If your blood pressure is constantly high, you should also seek medical advice.

A high blood pressure puts strain on your body. This year-long effort to pump blood through your body puts strain on your cardiovascular system (heart and blood vessels).

Therefore, there are limits for high blood pressure, so that your medical examiner can write you airworthy.

Limit values of the FAA and EASA

In the FAA, the systolic limit is 155 mmHg and the diastolic limit is 95 mmHg for blood pressure. If only one of the two limits is exceeded, you are already unfit to fly. Even if you are below the limit values, constant blood pressure values of over 140/90 should give you food for thought.

At the EASA the limit values are a little bit different. The systolic value must be below 160 mmHg and the diastolic blood pressure below 95 mmHg.

Medication and still airworthy

Many antihypertensive drugs are approved by both the FAA and EASA. Therefore a permanent medication does not lead to unfitness for flight.

Measures against high blood pressure

Whether you take medication or not, these measures are recommendations from the FAA to help you control high blood pressure:

1. reduce obesity if you are overweight.

2. sports activities

3. low salt diet

4. diet with little fat and many fruits and vegetables

Pilot with asthma?

The FAA makes the following statement about asthma:

"If the applicant rarely has mild symptoms, does not require hospitalization or steroid therapy, and has no symptoms in flight, the examiner may issue an aeromedical certificate.

Again, it is important to note that the decision lies with your national aviation authority. Therefore, your authority could deal with this issue differently.

Pilot with ADHS?

Attention deficit and hyperactivity syndrome (ADHS) is not a disease you need to report. However, you must pass the pilot tests. Depending on the severity, you will stand out through your behavior, which can then lead to rejection. Another problem is the lower resilience under stress. But as a pilot you have to be stress-resistant. Therefore the profession pilot will not come true.

According to the international guidelines it would be possible to issue a medical if everything is fine without medication. Nevertheless, the corresponding documents must be available to the medical examiner and checked by the appropriate authority.

There may be country-specific differences, so that you will not be spared the trip to the medical examiner. Only he or she will be able to tell you what your medical situation looks like.

Pilot with depression?

Statistically, every person suffers from depression at least once in his life. The question of how pilots deal with depression has been much discussed in connection with the Germanwings accident. Ultimately, it is an assessment by your medical examiner and the authorities as to whether you will receive, retain or give away your medical license with a diagnosed depression.

Are pilots allowed to smoke?

Pilots are just people like you and me. So some of them are also addicted to cigarettes. So even as a pilot you are allowed to smoke, even if your medical examiner doesn't like it so much. He will not forbid it to you. 

The problem of the smoker

But as a smoker, figuratively speaking, you're a high flyer.

Because by smoking, your lungs can absorb less oxygen per breath than if you didn't smoke. This is comparable to being a non-smoker and climbing a high mountain. There, the amount of oxygen per breath also decreases, resulting in the same effect.

So the non-smoker stands in the valley and the smoker rather on the mountain. You can really take a picture of this difference in altitude.

On earth we humans can breathe well. The higher we go up a mountain, the less oxygen we get and the less we can breathe and survive at that altitude. If you fly as a passenger or pilot with an airplane in 10 kilometers height, you would get too little oxygen and after a few breaths you would be unconscious. Therefore the cabin pressure is maintained at a pressure level equivalent to a height of about 2400 m above sea level.

As a smoker, however, you are always standing on the mountain. This means that your lungs cannot absorb as much oxygen as a non-smoker can. This altitude must also be added to the cruising altitude of the aircraft. You always fly higher than the rest of the people around you.

Drugs and alcohol in pilots?

According to the international aviation guidelines, states that have signed these guidelines are obliged to the following: They undertake to identify and remove licensees associated with the problematic consumption of substances from any positions considered critical to flight safety.

What does "problematic use of substances" mean now? This refers to any consumption of psychoactive substances that directly endangers the consumer or the life, health or well-being of others. And any consumption that causes or intensifies professional, social, mental or psychological problems or disorders.

Source: Manual of Civil Aviation Medicine Doc 8984 AN/895 Paragraph 1.2.35 

For drugs such as cannabis, heroin and marijuana, and psychoactive drugs, it is still quite easy to establish this connection. But even though alcohol is a legal drug in most countries, alcohol is considered a psychoactive substance and can also lead to problems with your license and medical if you consume too much.

Are tattoos allowed on pilots?

Opinions on implementation often differ on this issue. Some people feel restricted in their personality when they receive regulations from their employer regarding body jewellery and body art.

But the airlines pay a lot of attention to how they and their employees are seen in public. They want to convey a certain image and as a pilot you are the figurehead of the airline. You will travel to work in public in uniform on public transport. Or, at the latest, be noticed by passengers in the airport and on the plane.

Therefore, there is a mandatory uniform policy that you must adhere to.

With regard to tattoos and piercings, you will usually find similar formulations to the following.

Tattoos

Visible small tattoos are allowed if they do not exceed a certain size. A guideline for a small tattoo is a maximum size of 2cm x 2cm. In addition, visible tattoos for the service must be covered. Plasters are not allowed.

Larger tattoos must be able to be covered by the uniform. If a tattoo cannot be covered by a short blouse or shirt, you must wear a long blouse or shirt. Especially in summer this can be unpleasant.

Tattoos on the hand, neck and face are not allowed. 

Piercings

Piercings must not be visible. Only small ear studs are allowed.

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