European Aviation Safety Agency Acceptable Means of Compliance and 1 Guidance Material to Part-MED Initial issue 15 December 2011 1 Acceptable Means of Compliance and Guidance Material to Commission Regulation (EU) No 1178/2011 of 3 November 2011 laying down technical requirements and administrative procedures related to civil aviation aircrew pursuant to Regulation (EC) No 216/2008 of the European Parliament and of the Council. Page 1 of 61 Annex to ED Decision 2011/015/R TABLE OF CONTENTS SUBPART A 5 General requirements 5 Section 1 5 General 5 AMC1 MED.A.015 Medical confidentiality 5 AMC1 MED.A.020 Decrease in medical fitness 5 AMC1 MED.A.025 Obligations of AeMC, AME, GMP and OHMP 5 Section 2 5 Requirements for medical certificates 5 AMC1 MED.A.030 Medical certificates 5 AMC1 MED.A.035 Application for a medical certificate 6 AMC1 MED.A.045 Validity, revalidation and renewal of medical certificates 6 SUBPART B 7 Specific requirements for class 1, class 2 and LAPL medical certificates 7 AMC for class 1, class 2 and LAPL medical certificates 7 Section 1 7 General 7 AMC1 MED.B.001 Limitations to class 1, class 2 and LAPL medical certificates 7 GM1 MED.B.001 Limitation codes 8 Section 2 9 Specific requirements for class 1 medical certificates 9 AMC1 MED.B.010 Cardiovascular system 9 AMC1 MED.B.015 Respiratory system 16 AMC1 MED.B.020 Digestive system 17 AMC1 MED.B.025 Metabolic and endocrine systems 18 AMC1 MED.B.030 Haematology 18 AMC1 MED.B.035 Genitourinary system 19 AMC1 MED.B.040 Infectious disease 20 AMC1 MED.B.045 Obstetrics and gynaecology 21 AMC1 MED.B.050 Musculoskeletal system 21 AMC1 MED.B.055 Psychiatry 21 AMC1 MED.B.060 Psychology 22 AMC1 MED.B.065 Neurology 23 AMC1 MED.B.070 Visual system 24 AMC1 MED B.075 Colour vision 27 AMC1 MED.B.080 Otorhino-laryngology 27 AMC1 MED.B.085 Dermatology 28 AMC1 MED.B.090 Oncology 28 Section 3 29 Specific requirements for class 2 medical certificates 29 AMC2 MED.B.010 Cardiovascular system 29 AMC2 MED.B.015 Respiratory system 32 AMC2 MED.B.020 Digestive system 33 AMC2 MED.B.025 Metabolic and endocrine systems 33 Page 2 of 61 Annex to ED Decision 2011/015/R AMC2 MED.B.030 Haematology 34 AMC2 MED.B.035 Genitourinary system 35 AMC2 MED.B.040 Infectious diseases 35 AMC2 MED.B.045 Obstetrics and gynaecology 36 AMC2 MED.B.050 Musculoskeletal system 36 AMC2 MED.B.055 Psychiatry 36 AMC2 MED.B.060 Psychology 37 AMC2 MED.B.065 Neurology 37 AMC2 MED.B.070 Visual system 37 AMC2 MED B.075 Colour vision 38 AMC2 MED.B.080 Otorhino-laryngology 39 AMC2 MED.B.085 Dermatology 40 AMC MED.B.090 Oncology 40 Section 4 41 Specific requirements for LAPL medical certificates 41 AMC1 MED.B.095 Medical examination and/or assessment of applicants for LAPL medical certificates 41 AMC2 MED.B.095 Cardiovascular system 41 AMC3 MED.B.095 Respiratory system 42 AMC4 MED.B.095 Digestive system 43 AMC5 MED.B.095 Metabolic and endocrine systems 43 GM1 MED.B.095 Diabetes mellitus Type 2 treated with insulin 45 AMC6 MED.B.095 Haematology 45 AMC7 MED.B.095 Genitourinary system 45 AMC8 MED.B.095 Infectious disease 45 AMC9 MED.B.095 Obstetrics and gynaecology 45 AMC10 MED.B.095 Musculoskeletal system 45 AMC11 MED.B.095 Psychiatry 46 AMC12 MED.B.095 Psychology 46 AMC13 MED.B.095 Neurology 46 AMC14 MED.B.095 Visual system 47 AMC15 MED.B.095 Colour vision 47 AMC16 MED.B.095 Otorhino-laryngology 48 SUBPART C 49 Requirements for medical fitness of cabin crew 49 Section 1 49 General requirements 49 AMC1 MED.C.005 Aero-medical assessments 49 Section 2 49 Requirements for aero-medical assessment of cabin crew 49 AMC1 MED.C.025 Content of aero-medical assessments 49 AMC2 MED.C.025 Cardiovascular system 49 AMC3 MED.C.025 Respiratory system 51 AMC4 MED.C.025 Digestive system 51 AMC5 MED.C.025 Metabolic and endocrine systems 52 AMC6 MED.C.025 Haematology 52 Page 3 of 61 Annex to ED Decision 2011/015/R AMC7 MED.C.025 Genitourinary system 52 AMC8 MED.C.025 Infectious disease 52 AMC9 MED.C.025 Obstetrics and gynaecology 53 AMC10 MED.C.025 Musculoskeletal system 53 AMC11 MED.C.025 Psychiatry 53 AMC12 MED.C.025 Psychology 53 AMC13 MED.C.025 Neurology 53 AMC14 MED.C.025 Visual system 54 AMC15 MED.C.025 Colour vision 54 AMC16 MED.C.025 Otorhino-laryngology 55 AMC17 MED.C.025 Dermatology 55 AMC18 MED.C.025 Oncology 55 GM1 MED.C.025 Content of aero-medical assessments 56 Section 3 58 Additional requirements for applicants for, and holders of, a cabin crew attestation 58 AMC1 MED.C.030 Cabin crew medical report 58 AMC1 MED.C.035 Limitations 59 SUBPART D 60 Aero-medical examiners (AMEs) 60 AMC1 MED.D.010 Requirements for the issue of an AME certificate 60 AMC1 MED.D.015 Requirements for the extension of privileges 60 GM1 MED.D.030 Refresher training in aviation medicine 61 Page 4 of 61 Annex to ED Decision 2011/015/R AMC/GM to PART-MEDICAL SUBPART A General requirements Section 1 General AMC1 MED.A.015 Medical confidentiality To ensure medical confidentiality, all medical reports and records should be securely held with accessibility restricted to personnel authorised by the medical assessor. AMC1 MED.A.020 Decrease in medical fitness If in any doubt about their fitness to fly, use of medication or treatment: (a) holders of class 1 or class 2 medical certificates should seek the advice of an AeMC or AME; (b) holders of LAPL medical certificates should seek the advice of an AeMC, AME, or of the GMP who issued the holder’s medical certificate; (c) suspension of exercise of privileges: holders of a medical certificate should seek the advice of an AeMC or AME when they have been suffering from any illness involving incapacity to function as a member of the flight crew for a period of at least 21 days. AMC1 MED.A.025 Obligations of AeMC, AME, GMP and OHMP (a) The report required in MED.A.025 (b)(4) should detail the results of the examination and the evaluation of the findings with regard to medical fitness. (b) The report may be submitted in electronic format, but adequate identification of the examiner should be ensured. (c) If the medical examination is carried out by two or more AMEs or GMPs, only one of them should be responsible for coordinating the results of the examination, evaluating the findings with regard to medical fitness, and signing the report. Section 2 Requirements for medical certificates AMC1 MED.A.030 Medical certificates (a) A class 1 medical certificate includes the privileges and validities of class 2 and LAPL medical certificates. (b) A class 2 medical certificate includes the privileges and validities of a LAPL medical certificate. Page 5 of 61 Annex to ED Decision 2011/015/R AMC1 MED.A.035 Application for a medical certificate When applicants do not present a current or previous medical certificate to the AeMC, AME or GMP prior to the relevant examinations, the AeMC, AME or GMP should not issue the medical certificate unless relevant information is received from the licensing authority. AMC1 MED.A.045 Validity, revalidation and renewal of medical certificates The validity period of a medical certificate (including any associated examination or special investigation) is determined by the age of the applicant at the date of the medical examination. Page 6 of 61 Annex to ED Decision 2011/015/R Subpart B Specific requirements for class 1, class 2 and LAPL medical certificates AMC for class 1, class 2 and LAPL medical certificates Section 1 General AMC1 MED.B.001 Limitations to class 1, class 2 and LAPL medical certificates (a) An AeMC or AME may refer the decision on fitness of the applicant to the licensing authority in borderline cases or where fitness is in doubt. (b) In cases where a fit assessment can only be considered with a limitation, the AeMC, AME or the licensing authority should evaluate the medical condition of the applicant in consultation with flight operations and other experts, if necessary. (c) Limitation codes: Code Limitation 1 TML restriction of the period of validity of the medical certificate 2 VDL correction for defective distant vision 3 VML correction for defective distant, intermediate and near vision 4 VNL correction for defective near vision 5 CCL correction by means of contact lenses only 6 VCL valid by day only 7 HAL valid only when hearing aids are worn 8 APL valid only with approved prosthesis 9 OCL valid only as co-pilot 10 OPL valid only without passengers (PPL and LAPL only) 11 SSL special restriction as specified 12 OAL restricted to demonstrated aircraft type 13 AHL valid only with approved hand controls 14 SIC specific regular medical examination(s) - contact licensing authority 15 RXO specialist ophthalmological examinations (d) Entry of limitations (1) Limitations 1 to 4 may be imposed by an AME or an AeMC. (2) Limitations 5 to 15 should only be imposed: (i) for class 1 medical certificates by the licensing authority; Page 7 of 61 Annex to ED Decision 2011/015/R (ii) for class 2 medical certificates by the AME or AeMC in consultation with the licensing authority; (iii) for LAPL medical certificates by an AME or AeMC. (e) Removal of limitations (1) For class 1 medical certificates, all limitations should only be removed by the licensing authority. (2) For class 2 medical certificates, limitations may be removed by the licensing authority or by an AeMC or AME in consultation with the licensing authority. (3) For LAPL medical certificates, limitations may be removed by an AeMC or AME. GM1 MED.B.001 Limitation codes TML Time limitation The period of validity of the medical certificate is limited to the duration as shown on the medical certificate. This period of validity commences on the date of the medical examination. Any period of validity remaining on the previous medical certificate is no longer valid. The pilot should present him/herself for re-examination when advised and should follow any medical recommendations. VDL Wear corrective lenses and carry a spare set of spectacles Correction for defective distant vision: whilst exercising the privileges of the licence, the pilot should wear spectacles or contact lenses that correct for defective distant vision as examined and approved by the AME. Contact lenses may not be worn until cleared to do so by the AME. If contact lenses are worn, a spare set of spectacles, approved by the AME, should be carried. VML Wear multifocal spectacles and carry a spare set of spectacles Correction for defective distant, intermediate and near vision: whilst exercising the privileges of the licence, the pilot should wear spectacles that correct for defective distant, intermediate and near vision as examined and approved by the AME. Contact lenses or full frame spectacles, when either correct for near vision only, may not be worn. VNL Have available corrective spectacles and carry a spare set of spectacles Correction for defective near vision: whilst exercising the privileges of the licence, the pilot should have readily available spectacles that correct for defective near vision as examined and approved by the AME. Contact lenses or full frame spectacles, when either correct for near vision only, may not be worn. VCL Valid by day only The limitation allows private pilots with varying degrees of colour deficiency to exercise the privileges of their licence by daytime only. Applicable to class 2 medical certificates only. OML Valid only as or with qualified co-pilot This applies to crew members who do not meet the medical requirements for single crew operations, but are fit for multi-crew operations. Applicable to class 1 medical certificates only. OCL Valid only as co-pilot This limitation is a further extension of the OML limitation and is applied when, for some well defined medical reason, the pilot is assessed as safe to operate in a co-pilot role but not in command. Applicable to class 1 medical certificates only. Page 8 of 61 Annex to ED Decision 2011/015/R OPL Valid only without passengers This limitation may be considered when a pilot with a musculoskeletal problem, or some other medical condition, may involve an increased element of risk to flight safety which might be acceptable to the pilot but which is not acceptable for the carriage of passengers. Applicable to class 2 and LAPL medical certificates only. OSL Valid only with safety pilot and in aircraft with dual controls The safety pilot is qualified as PIC on the class/type of aircraft and rated for the flight conditions. He/she occupies a control seat, is aware of the type(s) of possible incapacity that the pilot whose medical certificate has been issued with this limitation may suffer and is prepared to take over the aircraft controls during flight. Applicable to class 2 and LAPL medical certificates only. OAL Restricted to demonstrated aircraft type This limitation may apply to a pilot who has a limb deficiency or some other anatomical problem which had been shown by a medical flight test or flight simulator testing to be acceptable but to require a restriction to a specific type of aircraft. SIC Specific regular medical examination(s) contact licensing authority This limitation requires the AME to contact the licensing authority before embarking upon renewal or recertification medical assessment. It is likely to concern a medical history of which the AME should be aware prior to undertaking the assessment. RXO Specialist ophthalmological examinations Specialist ophthalmological examinations are required for a significant reason. The limitation may be applied by an AME but should only be removed by the licensing authority. Section 2 Specific requirements for class 1 medical certificates AMC1 MED.B.010 Cardiovascular system (a) Examination Exercise electrocardiography An exercise ECG when required as part of a cardiovascular assessment should be symptom limited and completed to a minimum of Bruce Stage IV or equivalent. (b) General (1) Cardiovascular risk factor assessment (i) Serum lipid estimation is case finding and significant abnormalities should require review, investigation and supervision by the AeMC or AME in consultation with the licensing authority. (ii) An accumulation of risk factors (smoking, family history, lipid abnormalities, hypertension, etc.) should require cardiovascular evaluation by the AeMC or AME in consultation with the licensing authority. (2) Cardiovascular assessment (i) Reporting of resting and exercise electrocardiograms should be by the AME or an accredited specialist. Page 9 of 61 Annex to ED Decision 2011/015/R (ii) The extended cardiovascular assessment should be undertaken at an AeMC or may be delegated to a cardiologist. (c) Peripheral arterial disease If there is no significant functional impairment, a fit assessment may be considered by the licensing authority, provided: (1) applicants without symptoms of coronary artery disease have reduced any vascular risk factors to an appropriate level; (2) applicants should be on acceptable secondary prevention treatment; (3) exercise electrocardiography is satisfactory. Further tests may be required which should show no evidence of myocardial ischaemia or significant coronary artery stenosis. (d) Aortic aneurysm (1) Applicants with an aneurysm of the infra-renal abdominal aorta may be assessed as fit with a multi-pilot limitation by the licensing authority. Follow-up by ultra-sound scans or other imaging techniques, as necessary, should be determined by the licensing authority. (2) Applicants may be assessed as fit by the licensing authority after surgery for an infra-renal aortic aneurysm with a multi-pilot limitation at revalidation if the blood pressure and cardiovascular assessment are satisfactory. Regular cardiological review should be required. (e) Cardiac valvular abnormalities (1) Applicants with previously unrecognised cardiac murmurs should undergo evaluation by a cardiologist and assessment by the licensing authority. If considered significant, further investigation should include at least 2D Doppler echocardiography or equivalent imaging. (2) Applicants with minor cardiac valvular abnormalities may be assessed as fit by the licensing authority. Applicants with significant abnormality of any of the heart valves should be assessed as unfit. (3) Aortic valve disease (i) Applicants with a bicuspid aortic valve may be assessed as fit if no other cardiac or aortic abnormality is demonstrated. Follow-up with echocardiography, as necessary, should be determined by the licensing authority. (ii) Applicants with aortic stenosis require licensing authority review. Left ventricular function should be intact. A history of systemic embolism or significant dilatation of the thoracic aorta is disqualifying. Those with a mean pressure gradient of up to 20 mmHg may be assessed as fit. Those with mean pressure gradient above 20 mmHg but not greater than 40 mmHg may be assessed as fit with a multi-pilot limitation. A mean pressure gradient up to 50 mmHg may be acceptable. Follow-up with 2D Doppler echocardiography, as necessary, should be determined by the licensing authority. Alternative measurement techniques with equivalent ranges may be used. (iii) Applicants with trivial aortic regurgitation may be assessed as fit. A greater degree of aortic regurgitation should require a multi-pilot limitation. There should be no demonstrable abnormality of the ascending aorta on 2D Doppler echocardiography. Follow-up, as necessary, should be determined by the licensing authority. Page 10 of 61