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Requirements Visual Acuity Class 2 Distance monocular: > 0,5 Distance binocular > 0,7  Contact lenses Contact lenses must be monofocal and not tinted Contact lenses to correct astigmatism (toric lenses) are allowed Correction – all classes For d...

Requirements Visual Acuity Class 2 Distance monocular: > 0,5 Distance binocular > 0,7  Contact lenses Contact lenses must be monofocal and not tinted Contact lenses to correct astigmatism (toric lenses) are allowed Correction – all classes For distant vision (VDL) spectacles or contact lenses a spare set of similarly correcting spectacles shall be readily available for immediate use if contact lenses are worn, they shall be for distant vision, monofocal, non-tinted and well tolerated applicants with a large refractive error shall use contact lenses or high-index spectacle lenses Limitations  VDL: Correction for defective distant vision Wear corrective lenses and carry a spare set of spectacles Contact lenses may not be worn until declared so by the AME or AeMC If contact lenses are worn a spare set of spectacles should be carried  VNL: Correction for defective near vision a pair of spectacles for near use shall be kept (Vision Near Limitation) readily available a spare set of similarly correcting spectacles shall be readily available for immediate use  VML: Correction for defective distant, near and intermediate vision (Vision Multifocal Limitation) Wear spectacles that correct for defective distant, intermediate and near vision and carry a spare set of spectacles What are the additional challenges of suborbital/ parabolic flights? Acceleration and deceleration forces Motion sickness Weightlessness Hypoxia Pressure difference Small and possibly crowded cabin Extraordinary psychological situation RELATION TO AVIATION RISK OF INCAPACITATION The endocrine system is generally characterized by high plasticity, so that risk of incapacitation most often gets back to residual after acute disorders are over Most frequent causes of incapacitation in endocrine disorders: forgetfulness, lack of attention, poor reactivtiy (hypothyroidism) nervous system excitation and tachyarhythmia (hyperthyroidism or acute thyroiditis) asthenia, fainting and arrhythmia (hypoadrenalism) severe headache and impaired vision (large pituitary adenoma) trouble moving, reactive depression and eventually occurring OSAS (obesity) hypoglycemia (diabetes mellitus) any signs of eventually occurring overtreatment DIABETES RULES MED.B.095 AMC 5 (d) Diabetes mellitus 1) The use of antidiabetic medications that are not likely to cause hypoglycaemia should be acceptable for a fit assessment. 2) Applicants with diabetes mellitus Type 1 should be assessed as unfit- 3) Applicants with diabetes mellitus Type 2 treated with insulin may be assessed as fit with limitations for revalidation if blood sugar control has been achieved and the process under (e) and (f) below is followed (e) An OSL limitation is required. A TML limitation for 12 months may be needed to ensure compliance with the follow-up requirements. (f) Licence privileges should be restricted to aeroplanes and sailplanes only. So, Type 2 is the only allowed option. f) ACTIONS REQUESTED FROM PILOT COMPARISON OF TYPE 1 AND TYPE 2 DM frequency ≈ 10% ≈ 90% adapted form Wolosowicz Met al. Int J Environ Res Public Health. 2020 Nov 21;17(22):8651. doi: 10.3390/ijerph17228651. 26/07/2024 The ESAM ACADEMY 98 26/07/2024 The ESAM ACADEMY 99 26/07/2024 The ESAM ACADEMY 100 26/07/2024 The ESAM ACADEMY 101 26/07/2024 The ESAM ACADEMY 102 (e) AEROMEDICAL ASSESSMENT 26/07/2024 The ESAM ACADEMY 104  Loop diuretic (Furosemid) is not allowed for class 2 hypertensive therapy 26/07/2024 The ESAM ACADEMY 105 26/07/2024 The ESAM ACADEMY 106 26/07/2024 The ESAM ACADEMY 107 26/07/2024 The ESAM ACADEMY 108 26/07/2024 The ESAM ACADEMY 109 26/07/2024 The ESAM ACADEMY 110 26/07/2024 The ESAM ACADEMY 111 26/07/2024 The ESAM ACADEMY 112 26/07/2024 The ESAM ACADEMY 113 26/07/2024 The ESAM ACADEMY 114 26/07/2024 The ESAM ACADEMY 115 26/07/2024 The ESAM ACADEMY 116 26/07/2024 The ESAM ACADEMY 117 26/07/2024 The ESAM ACADEMY 118 26/07/2024 The ESAM ACADEMY 119 26/07/2024 The ESAM ACADEMY 120 26/07/2024 The ESAM ACADEMY 121 26/07/2024 The ESAM ACADEMY 122 26/07/2024 The ESAM ACADEMY 123 26/07/2024 The ESAM ACADEMY 124 26/07/2024 The ESAM ACADEMY 125 26/07/2024 The ESAM ACADEMY 126 26/07/2024 The ESAM ACADEMY 127 26/07/2024 The ESAM ACADEMY 128 26/07/2024 The ESAM ACADEMY 129 26/07/2024 The ESAM ACADEMY 130 26/07/2024 The ESAM ACADEMY 131 26/07/2024 The ESAM ACADEMY 132 26/07/2024 The ESAM ACADEMY 133 26/07/2024 The ESAM ACADEMY 134 26/07/2024 The ESAM ACADEMY 135 26/07/2024 The ESAM ACADEMY 136 26/07/2024 The ESAM ACADEMY 137 26/07/2024 The ESAM ACADEMY 138 AMC2 MED.B.045 Obstetrics and gynaecology Pilot Class 2 1.(a) Gynaecological surgery 2.Applicants who have undergone a major gynaecological operation should be assessed as unfit until recovery is complete, the applicant is asymptomatic, and the risk of secondary complication or recurrence is minimal. 3.(b) Pregnancy 1. (1) A pregnant licence holder may be assessed as fit during the first 26 weeks of gestation following satisfactory obstetric evaluation. 2. (2) Licence privileges may be resumed upon satisfactory confirmation of full recovery following confinement or termination of pregnancy.  Pilot LAPL AMC9 MED.B.095 Medical examination and assessment of applicants for LAPL medical certificates OBSTETRICS AND GYNAECOLOGY 1.(a) Pregnancy 2.Holders of a LAPL medical certificate should only exercise the privileges of their licences until the end of the 26th week of gestation under routine antenatal care. 3.(b) Applicants who have undergone a major gynaecological operation may be assessed as fit after recovery.  Crew Member AMC9 MED.C.025 Content of aero-medical assessments OBSTETRICS AND GYNAECOLOGY 1.(a) Cabin crew members who have undergone a major gynaecological operation should be assessed as unfit until after recovery. 2.(b) Pregnancy (1)A pregnant cabin crew member may be assessed as fit only during the first 16 weeks of gestation following review of the obstetric evaluation by the AME or OHMP. (2) A limitation not to perform duties as single cabin crew member should be considered. (3) The AME or OHMP should provide written advice to the cabin crew member and supervising physician regarding potentially significant complications of pregnancy resulting from flying duties.  To summarize for Class 1 When pregnant an expertise is needed to be declared fit What are the conditions ? for flying up to 26 GA with OML restriction – Information delivered to the women and her obstetrician – A voluntary demand from the woman (of course !) The following items must be considered with the Women – Follow up as early as possible – No invalidant symptoms of early pregancy – Legislation on radiation (< 1 mSv/y) and possibilities to avoid – Low risk pregnancy ( age, no significant obstétrical background ( multiple miscarriage, preterm – Thrombo embolic risk and possibilities to avoid labor , SGA ….) – Tiredness, stress, work conditions (ergonomia) – Obstetrical and infectious risk in poor ressource remote countries – Potentially exclude »precious pregnancy » ( Age, ART…) – Consideration on the ability to face an inflight incident or accident ( emergency evacuation) – Singleton Intra uterine pregnancy without any clinical obstetrical sign (bleeding…) – Human factors : exterior sight on a pregnant professional – EARLY ECHOGRAPHIC SCANNING Deliver a documentation on theses considerations – Monthly follow up at AeMC coupled with an evaluation of the Obstetrician stating that the pregnancy is going on normaly (!!) – Now last visit at 22 GA  To summarize for Air crew When pregnant an expertise is needed to be declared fit What are the conditions ? for flying up to 16 GA with consideration not to be single cabin crew – Information delivered to the women and her obstetrician – A voluntary demand from the woman (of course !) – Follow up as early as possible The following items must be considered with the Women – No invalidant symptoms of early pregancy – Low risk pregnancy ( age, no significant obstetrical background ( multiple miscarriage, preterm – Legislation on radiation (< 1 mSv/y) and possibilities to avoid labor , SGA ….) – Thrombo embolic risk and possibilities to avoid – Potentially exclude »precious pregnancy » ( Age, ART…) – Tiredness, stress, work conditions (ergonomia) – Singleton Intra uterine pregnancy without any clinical obstetrical sign (bleeding…) – Obstetrical and infectious risk in poor ressource remote countries – EARLY ECHOGRAPHIC SCANNING – Consideration on the ability to face an inflight incident or accident ( emergency evacuation) – Monthly follow up at AeMC coupled with an evaluation of the Obstetrician stating that the – Human factors : exterior sight on a pregnant professional pregnancy is going on normaly (!!) Deliver a documentation on these considerations Finaly there is a little time between the « official » diagnosis and the end point of 16 GA Plead for an early declaration as possible ( depends on the crew ) Gynecology Fibroma , endometriosis and adenomyosis can deserve more frequently a surgery than a medical treatment to avoid: Sudden incapacitation due to Pain Heavy bleeding The patient must be aware that the therapy can be guided by their professional necessity Informed consent is crucial 26/07/2024 The ESAM ACADEMY 144 26/07/2024 The ESAM ACADEMY 145 26/07/2024 The ESAM ACADEMY 146 26/07/2024 The ESAM ACADEMY 147 26/07/2024 The ESAM ACADEMY 148  https://www.aafp.org/content/dam/brand/aafp/pubs/afp/issu es/2013/1201/p747-t1.gif 26/07/2024 The ESAM ACADEMY 149 Take Home Message Neurology and Aviation An applicant with a head injury which was severe enough to cause loss of consciousness or is associated with penetrating brain injury should be reviewed by a consultant neurologist. Essential is the full recovery and a low risk of epilepsy Neurolgy and vascular symptoms: >Time is brain< www.yashodahospitals.c om/brain-stroke- emergency-care/ 26/07/2024 The ESAM ACADEMY 150 Take Home Message Episode of disturbance of consciousness In case of a single episode of disturbance of consciousness, which can be satisfactorily explained, a fit assessment may be considered, but a recurrence should be disqualifying. Conditions with a high propensity for cerebral dysfunction An applicant with a condition with a high propensity for cerebral dysfunction should be assessed as unfit. A fit assessment may be considered after full evaluation. 26/07/2024 The ESAM ACADEMY 151 Migraine Applicants with an established diagnosis of migraine or other severe periodic headaches likely to cause a hazard to flight safety should be assessed as unfit. A fit assessment may be considered after full evaluation. The evaluation should take into account at least the following: auras, visual field loss, frequency, severity, and therapy. Appropriate limitation(s) may apply. 26/07/2024 The ESAM ACADEMY 152 Take home messages Urological in-flight medical incapacitations are rare Urological manifestations during the aeromedical examination are (very) common Be pragmatic and use your clinical skills Communicate your thoughts & decision Aviation safety is your key role 26/07/2024 The ESAM ACADEMY 153 26/07/2024 The ESAM ACADEMY 154 26/07/2024 The ESAM ACADEMY 155 26/07/2024 The ESAM ACADEMY 156 26/07/2024 The ESAM ACADEMY 157 26/07/2024 The ESAM ACADEMY 158 26/07/2024 The ESAM ACADEMY 159 26/07/2024 The ESAM ACADEMY 160 26/07/2024 The ESAM ACADEMY 161 26/07/2024 The ESAM ACADEMY 162 26/07/2024 The ESAM ACADEMY 163 26/07/2024 The ESAM ACADEMY 164 26/07/2024 The ESAM ACADEMY 165