Information on the Aviation Medical

This article was prepared for various flying clubs to run on their websites, explaining aviation medical examinations. As such it is generic, and not specific to this clinic.

As one approaches the exciting prospect of learning to fly an aircraft, one of the first areas of concern is often the fact that a medical examination will have to be completed. The purpose of this brief article is to address this examination, and perhaps demystify some of the concerns you may have had surrounding the whole issue of medical fitness to fly.

Since the start of aviation, it has been recognized that the flight environment makes special demands upon the human body. Medical examinations have been instituted from the very earliest days of aviation. These examinations have evolved, over decades, to form the medical standards of the International Civil Aviation Organization, to which Canada is a signatory. The medical standards that must be met by private or commercial pilots are thus international, and not merely a Canadian matter. Each member state of ICAO is allowed some latitude in interpreting the standards, but you will find them very similar around the world.

It is a common myth that one need be “super human” or in the pinnacle of physical condition in order to fly. Basically, one must be healthy. The exact standards are set out in the CARs, a copy of which may be found on the web via Transport Canada. I will assume, however, for the purposes of this article, that the Reader is not familiar with the CARs. The mechanics of the medical examination are as follows. Private pilots must hold a medical certificate entitled “category 3”, while commercial or airline transport licensed pilots must hold a medical certificate entitled “category 1”. The medical standards, and validity periods, for each of these categories are different. A category 4 medical is held by recreational pilots, and is obtained by filling out a self declaration form with any doctor, an aviation doctor is not necessary. Category 3 and category 1 medical certificates can only be obtained by undergoing a specified medical examination with one of the designated aviation medical examiners (AME). A list of Civil Aviation Medical Examiners is available on the web. These doctors have special training in aviation medicine, and performing the aviation medical examination. They will determine whether you meet the standards for either category 3 or category 1, and make a recommendation to Transport Canada, Civil Aviation Medicine, on your behalf. The final decision as to whether you meet standards, or not, rests with the Regional Aviation Medical Officer (RAMO).

Should you disagree with the decision, you have an opportunity to submit further medical information to the Aviation Medical Review Board for their consideration. Should you still be turned down, and disagree with this, you have a right to a public hearing at the Civil Aviation Tribunal.

Two minor items. Firstly, unlike a car, you may fly an airplane (dual) accompanied by a licensed pilot, without possessing any type of student pilot permit or medical certificate. The airplane is deemed, in this case, to be under the control of the licensed pilot. Thus, you may start your flight instruction at any time, before undergoing a medical examination. It will be necessary for you to hold a student private permit, and valid medical certificate, to solo. Secondly, these aviation medical examinations, are not covered by Medicare, and must be paid for by the pilot. Depending where you are in Canada these medical examination costs anywhere from $150 to $230 dollars. Tests, such as ECGs or audiograms, are extra.

Now, what are these medical standards you must meet?

Fundamentally, you must be healthy. The medical standards are described by body system. Covering the most common medical problems seen by aviation medical physicians, you must:

  • Have adequate vision (glasses are permitted) better than 20/30. If you have had laser eye surgery you may still be licensed.
  • Have adequate hearing (able to hear whispered speech at 6 m). If your hearing is not this good, there are practical tests which may be performed which will still permit you to be licensed, although you may be required to wear a headset when flying a radio equipped aircraft.
  • Be free of any significant, ongoing illness which might result in impairment of consciousness or inability to operate the aircraft safely. It is possible to be licensed with a variety of illnesses, as long as those illnesses are under good control. The topic of medication often comes up. Medications are not permitted when they may have side effects or therapeutic effects which impair a pilot’s ability to operate the aircraft. An example would be narcotic pain-killers. Secondly, certain medications may not be impairing in and of themselves, but their use implies an underlying illness which would not permit the safe piloting of an aircraft. An example would be chemotherapy agents for the treatment of active cancer. Blood pressure must be adequately controlled, although medications are acceptable. A past history of significant heart disease, or lung disease, will be thoroughly investigated to ensure that the pilot has recovered adequately, and is now safe. It is possible to be licensed to fly an aircraft even after one has had a heart attack, provided certain criteria are met. Various handicaps such as missing limbs are also acceptable, provided the pilot is capable of moving all of the control surfaces of the aircraft through their full course of travel, and is capable of exiting the aircraft in an emergency. It may be necessary to be limited to certain, specially equipped, aircraft to permit handicapped pilots to fly.

Obviously, an article like this must be extremely general. Specific circumstances vary so much that the best advice for anyone contemplating flying lessons would be to complete a Transport Canada medical examination if they are in any doubt as to their fitness. Generally, your flight instructor can advise you, or put you in touch with someone such as an aviation medical examiner, who can give more specific advice in your case. Overall, Transport Canada, Civil Aviation Medicine, is anxious to see that anyone who desires to fly an aircraft, and is safe to do so, is allowed to exercise this privilege, and join the flying fraternity. If you have always held back because of health concerns, perhaps now is the time to reconsider, as things may be better than you thought!