MED.D.020 Training courses in aviation medicine

BASIC TRAINING COURSE

(a)Basic training course for AMEs The basic training course for AMEs should consist of 60 hours of theoretical and practical training, including specific examination techniques.

(b)The learning objectives to acquire the necessary competencies should include theoretical knowledge, risk management, and decision-making principles in the following subjects. Demonstrations and practical skills should also be included, where appropriate.

(1)Introduction to aviation medicine;

(2)Basic aeronautical knowledge;

(3)Aviation physiology;

(4)Cardiovascular system;

(5)Respiratory system;

(6)Digestive system;

(7)Metabolic and endocrine systems;

(8)Haematology;

(9)Genitourinary system;

(10)Obstetrics and gynaecology;

(11)Musculoskeletal system;

(12)Psychiatry;

(13)Psychology;

(14)Neurology;

(15)Visual system and colour vision;

(16)Otorhinolaryngology;

(17)Oncology;

(18)Incidents and accidents escape and survival;

(19)Medication and flying;

(20)Legislation, rules and regulations;

(21)Cabin crew working environment;

(22)In-flight environment; and

(23)Space medicine.

ADVANCED TRAINING COURSE

(a)Advanced training course for AMEs The advanced training course for AMEs should consist of 66 hours of theoretical and practical training, including specific examination techniques.

(b)The learning objectives to acquire the necessary competencies should include theoretical knowledge, risk management, and decision-making principles in the following subjects. Demonstrations and practical skills should also be included, where appropriate.

(1)Pilot working environment;

(2)Aerospace physiology;

(3)Clinical medicine;

(4)Cardiovascular system;

(5)Neurology;

(6)Psychiatry/psychology;

(7)Visual system and colour vision;

(8)Otorhinolaryngology;

(9)Dentistry;

(10)Human factors in aviation;

(11)Incidents and accidents, escape and survival; and

(12)Tropical medicine.

(c)Practical training in an AeMC should be under the guidance and supervision of the head of the AeMC.

(d)After the successful completion of the practical training, a report of demonstrated competency should be issued.

BASIC TRAINING COURSE

(a)Basic training course in aviation medicine 60 hours

(1)Introduction to aviation medicine 2 hours

(i)History of aviation medicine

(ii)Specific aspects of civil aviation medicine

(iii)Different types of recreational flying

(iv)AME and pilots relationship

(v)Responsibility of the AME in aviation safety

(vi)Communication and interview techniques

(2)Basic aeronautical knowledge 2 hours

(i)Flight mechanisms

(ii)Man-machine interface, informational processing

(iii)Propulsion

(iv)Conventional instruments, ‘glass cockpit’

(v)Recreational flying

(vi)Simulator/aircraft experience

(3)Aviation physiology 9 hours

(i)Atmosphere

(A)Functional limits for humans in flight

(B)Divisions of the atmosphere

(C)Gas laws — physiological significance

(D)Physiological effects of decompression

(ii)Respiration

(A)Blood gas exchange

(B)Oxygen saturation

(iii)Hypoxia signs and symptoms

(A)Average time of useful consciousness (TUC)

(B)Hyperventilation signs and symptoms

(C)Barotrauma

(D)Decompression sickness

(iv)Acceleration

(A)G-Vector orientation

(B)Effects and limits of G-load

(C)Methods to increase Gz-tolerance

(D)Positive/negative acceleration

(E)Acceleration and the vestibular system

(v)Visual disorientation

(A)Sloping cloud deck

(B)Ground lights and stars confusion

(C)Visual autokinesis

(vi)Vestibular disorientation

(A)Anatomy of the inner ear

(B)Function of the semicircular canals

(C)Function of the otolith organs

(D)The oculogyral and coriolis illusion

(E)‘Leans’

(F)Forward acceleration illusion of ‘nose up’

(G)Deceleration illusion of ‘nose down’

(H)Motion sickness — causes and management

(vii)Noise and vibration

(A)Preventive measures

(4)Cardiovascular system 3 hours

(i)Relation to aviation; risk of incapacitation

(ii)Examination procedures: ECG, laboratory testing and other special examinations

(iii)Cardiovascular diseases:

(A)Hypertension, treatment and assessment

(B)Ischaemic heart disease

(C)ECG findings

(D)Assessment of satisfactory recovery from myocardial infarction, interventional procedures and surgery

(E)Cardiomyopathies; pericarditis; rheumatic heart disease; valvular diseases

(F)Rhythm and conduction disturbances, treatment and assessment

(G)Congenital heart disease: surgical treatment, assessment

(H)Cardiovascular syncope: single and repeated episodes Topics (5) to (11) inclusive, and (17) 10 hours

(5)Respiratory system

(i)Relation to aviation, risk of incapacitation

(ii)Examination procedures: spirometry, peak flow, x-ray, other examinations

(iii)Pulmonary diseases: asthma, chronic obstructive pulmonary diseases

(iv)Infections, tuberculosis

(v)Bullae, pneumothorax

(vi)Obstructive sleep apnoea

(vii)Treatment and assessment

(6)Digestive system

(i)Relation to aviation, risk of incapacitation

(ii)Examination of the system

(iii)Gastro-intestinal disorders: gastritis, ulcer disease

(iv)Biliary tract disorders

(v)Hepatitis and pancreatitis

(vi)Inflammatory bowel disease, irritable colon/irritable bowel disease

(vii)Herniae

(viii)Treatment and assessment including post-abdominal surgery

(7)Metabolic and endocrine systems

(i)Relation to aviation, risk of incapacitation

(ii)Endocrine disorders

(iii)Diabetes mellitus Type 1 & 2

(A)Diagnostic tests and criteria

(B)Anti-diabetic therapy

(C)Operational aspects in aviation

(D)Satisfactory control criteria for aviation

(iv)Hyper/hypothyroidism

(v)Pituitary and adrenal glands disorders

(vi)Treatment and assessment

(8)Haematology

(i)Relation to aviation, risk of incapacitation

(ii)Blood donation aspects

(iii)Erythrocytosis; anaemia; leukaemia; lymphoma

(iv)Sickle cell disorders

(v)Platelet disorders

(vi)Haemoglobinopathies; geographical distribution; classification

(vii)Treatment and assessment

(9)Genitourinary system

(i)Relation to aviation, risk of incapacitation

(ii)Action to be taken after discovery of abnormalities in routine dipstick urinalysis, e.g. haematuria; albuminuria

(iii)Urinary system disorders:

(A)Nephritis; pyelonephritis; obstructive uropathies

(B)Tuberculosis

(C)Lithiasis: single episode; recurrence

(D)Nephrectomy, transplantation, other treatment and assessment

(10)Obstetrics and gynaecology

(i)Relation to aviation, risk of incapacitation

(ii)Pregnancy and aviation

(iii)Disorders, treatment and assessment

(11)Musculoskeletal system

(i)Vertebral column diseases

(ii)Arthropathies and arthroprosthesis

(iii)Pilots with a physical impairment

(iv)Treatment of musculoskeletal system, assessment for flying

(12)Psychiatry 2 hours

(i)Relation to aviation, risk of incapacitation

(ii)Psychiatric examination

(iii)Psychiatric disorders: neurosis; personality disorders; psychosis; organic mental illness

(iv)Alcohol and other psychoactive substance(s) use

(v)Treatment, rehabilitation and assessment

(13)Psychology 2 hours

(i)Introduction to psychology in aviation as a supplement to psychiatric assessment

(ii)Methods of psychological examination

(iii)Behaviour and personality

(iv)Workload management and situational awareness

(v)Flight motivation and suitability

(vi)Group social factors

(vii)Psychological stress, stress coping, fatigue

(viii)Psychomotor functions and age

(ix)Mental fitness and training

(14)Neurology 3 hours

(i)Relation to aviation, risk of incapacitation

(ii)Examination procedures

(iii)Neurological disorders

(A)Seizures — assessment of single episode

(B)Epilepsy

(C)Multiple sclerosis

(D)Head trauma

(E)Post-traumatic states

(F)Vascular diseases

(G)Tumours

(H)Disturbance of consciousness — assessment of single and repeated episodes

(iv)Degenerative diseases

(v)Sleep disorders

(vi)Treatment and assessment

(15)Visual system and colour vision 4 hours

(i)Anatomy of the eye

(ii)Relation to aviation duties

(iii)Examination techniques

(A)Visual acuity assessment

(B)Visual aids

(C)Visual fields — acceptable limits for certification

(D)Ocular muscle balance

(E)Assessment of pathological eye conditions

(F)Glaucoma

(iv)Monocularity and medical flight tests

(v)Colour vision

(vi)Methods of testing: pseudoisochromatic plates, lantern tests, anomaloscopy

(vii)Importance of standardisation of tests and of test protocols

(viii)Assessment after eye surgery

(16)Otorhinolaryngology 3 hours

(i)Anatomy of the systems

(ii)Clinical examination in ORL

(iii)Functional hearing tests

(iv)Vestibular system; vertigo, examination techniques

(v)Assessment after ENT surgery

(vi)Barotrauma ears and sinuses

(vii)Aeronautical ENT pathology

(viii)ENT requirements

(17)Oncology

(i)Relation to aviation, risk of metastasis and incapacitation

(ii)Risk management

(iii)Different methods of treatment and assessment

(18)Incidents and accidents, escape and survival 1 hour

(i)Accident statistics

(ii)Injuries

(iii)Aviation pathology, post-mortem examination, identification

(iv)Aircraft evacuation

(A)Fire

(B)Ditching

(C)By parachute

(19)Medication and flying 2 hours

(i)Hazards of medications

(ii)Common side effects; prescription medications; over-the-counter medications; herbal medications; ‘alternative’ therapies

(iii)Medication for sleep disturbance

(20)Legislation, rules and regulations 4 hours

(i)ICAO Standards and Recommended Practices, European provisions (e.g. Implementing Rules, AMC and GM)

(ii)Incapacitation: acceptable aero-medical risk of incapacitation; types of incapacitation; operational aspects

(iii)Basic principles in assessment of fitness for aviation

(iv)Operational and environmental conditions

(v)Use of medical literature in assessing medical fitness; differences between scientific study populations and licensed populations

(vi)Flexibility

(vii)Annex 1 to the Chicago Convention, paragraph 1.2.4.9

(viii)Accredited Medical Conclusion; consideration of knowledge, skill and experience

(ix)Trained versus untrained crews; incapacitation training

(x)Medical flight tests

(21)Cabin crew working environment 1 hour

(i)Cabin environment, workload, duty and rest time, fatigue risk management

(ii)Cabin crew safety duties and associated training

(iii)Types of aircraft and types of operations

(iv)Single-cabin crew and multi-cabin crew operations

(22)In-flight environment 1 hour

(i)Hygiene aboard aircraft: water supply, oxygen supply, disposal of waste, cleaning, disinfection and disinsection

(ii)Catering

(iii)Crew nutrition

(iv)Aircraft and transmission of diseases

(23)Space medicine 1 hour

(i)Microgravity and metabolism, life sciences

(24)Practical demonstrations of basic aeronautical knowledge 8 hours

(25)Concluding items 2 hours

(i)Final examination

(ii)De-briefing and critique

ADVANCED TRAINING COURSE

(a)Advanced training course in aviation medicine 66 hours

(1)Pilot working environment 6 hours

(i)Commercial aircraft flight crew compartment

(ii)Business jets, commuter flights, cargo flights

(iii)Professional airline operations

(iv)Fixed wing and helicopter, specialised operations including aerial work

(v)Air traffic control

(vi)Single-pilot/multi-pilot

(vii)Exposure to radiation and other harmful agents

(2)Aerospace physiology 4 hours

(i)Brief review of basics in physiology (hypoxia, rapid/slow decompression, hyperventilation, acceleration, ejection, spatial disorientation)

(ii)Simulator sickness

(3)Clinical medicine 5 hours

(i)Complete physical examination

(ii)Review of basics with relationship to commercial flight operations

(iii)Class 1 requirements

(iv)Clinical cases

(v)Communication and interview techniques

(4)Cardiovascular system 4 hours

(i)Cardiovascular examination and review of basics

(ii)Class 1 requirements

(iii)Diagnostic steps in cardiovascular system

(iv)Clinical cases

(5)Neurology 3 hours

(i)Brief review of basics (neurological and psychiatric examination)

(ii)Alcohol and other psychoactive substance(s) use

(iii)Class 1 requirements

(iv)Clinical cases

(6)Psychiatry/psychology 5 hours

(i)Brief review of basics (psychiatric/psychological evaluation techniques)

(ii)Alcohol and other psychoactive substance(s) use

(iii)Class 1 requirements

(iv)Clinical cases

(7)Visual system and colour vision 5 hours

(i)Brief review of basics (visual acuity, refraction, colour vision, visual fields, night vision, stereopsis, monocularity)

(ii)Class 1 visual requirements

(iii)Implications of refractive and other eye surgery

(iv)Clinical cases

(8)Otorhinolaryngology 4 hours

(i)Brief review of basics (barotrauma — ears and sinuses, functional hearing tests)

(ii)Noise and its prevention

(iii)Vibration, kinetosis

(iv)Class 1 hearing requirements

(v)Clinical cases

(9)Dentistry 2 hours

(i)Oral examination including dental formula

(ii)Oral cavity, dental disorders and treatment, including implants, fillings, prosthesis, etc.

(iii)Barodontalgia

(iv)Clinical cases

(10)Human factors in aviation, including 8 hours demonstration and practical experience 22 hours

(i)Long-haul flight operations

(A)Flight time limitations

(B)Sleep disturbance

(C)Extended/expanded crew

(D)Jet lag/time zones

(ii)Human information processing and system design

(A)Flight Management System (FMS), Primary Flight Display (PFD), datalink, fly by wire

(B)Adaptation to the glass cockpit

(C)Crew Coordination Concept (CCC), Crew Resource Management (CRM), Line Oriented Flight Training (LOFT) etc.

(D)Practical simulator training

(E)Ergonomics

(iii)Crew commonality

(A)Flying under the same type rating, e.g. A-318, A-319, A-320, A-321

(iv)Human factors in aircraft incidents and accidents

(v)Flight safety strategies in commercial aviation

(vi)Fear and refusal of flying

(vii)Psychological selection criteria

(viii)Operational requirements (flight time limitation, fatigue risk management, etc.)

(11)Incidents and accidents, escape and survival 2 hours

(i)Accident statistics

(ii)Types of injuries

(iii)Aviation pathology, post-mortem examination related to aircraft accidents, identification

(iv)Rescue and emergency evacuation

(12)Tropical medicine 2 hours

(i)Endemicity of tropical disease

(ii)Infectious diseases (communicable diseases, sexually transmitted diseases, HIV etc.)

(iii)Vaccination of flight crew and passengers

(iv)Diseases transmitted by vectors

(v)Food and water-borne diseases

(vi)Parasitic diseases

(vii)International health regulations

(viii)Personal hygiene of aviation personnel

(13)Concluding items 2 hours

(i)Final examination

(ii)De-briefing and critique

GENERAL

(a)Principles of training: To acquire knowledge and skills for the aero-medical examination and assessment, the training should be:

(1)based on regulations;

(2)based on general clinical skills and knowledge necessary to conduct relevant examinations for the different medical certificates;

(3)based on knowledge of the different risk assessments required for various types of medical certification;

(4)based on an understanding of the limits of the decision-making competences of an AME in assessing safety-critical medical conditions for when to defer and when to deny;

(5)based on knowledge of the aviation environment; and

(6)exemplified by clinical cases and practical demonstrations.

(b)Training outcomes: The trainee should demonstrate a thorough understanding of:

(1)the aero-medical examination and assessment process:

(i)principles, requirements and methods;

(ii)ability to investigate all clinical aspects that present aero-medical risks, the reasonable use of additional investigations;

(iii)the role in the assessment of the ability of the pilot or cabin crew member to safely perform their duties in special cases, such as the medical flight test;

(iv)aero-medical decision-making based on risk management;

(v)medical confidentiality; and

(vi)correct use of appropriate forms, and the reporting and storing of information;

(2)the conditions under which the pilots and cabin crew carry out their duties; and

(3)principles of preventive medicine, including aero-medical advice in order to help prevent future limitations.

(c)The principles and training outcomes stated at (a) and (b) should also be taken into consideration for refresher training programmes