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helicopter or powered-lift, multi-crew pilot licences — aeroplane, or airline transport pilot licences — aeroplane,
helicopter or powered-lift shall have their Class 1 Medical Assessments renewed at intervals not exceeding those
specified in 1.2.5.2.
6.3.1.2.1 Recommendation.- In alternate years, for Class 1 applicants under 40 years of age, the Licensing
Authority should, at its discretion, allow medical examiners to omit certain routine examination items related to
the assessment of physical fitness, whilst increasing the emphasis on health education and prevention of ill
health
Note.- Guidance for Licensing Authorities wishing to reduce the emphasis on detection of physical disease,
whilst increasing the emphasis on health education and prevention of ill health, in applicants under 40 years of
age, is contained in the Manual of Civil Aviation Medicine (Doc 8984)
ICAO Preliminary Unedited Version — October 2008 I-3-4
Class 1 applicants are required to have an annual medical examination from the time they commence
flying until they reach 60 years of age, after which the frequency becomes 6-monthly. The exception to
this is for the passenger-carrying single pilot operator, who requires a medical examination every six
months after age 40 years. The medical examination normally varies little during a pilot’s career,
although after the initial electrocardiogram (ECG) the frequency for ECGs increases with the pilot’s age,
initially as a Recommendation (two-yearly between ages 30-50 years) and then as a Standard (annually
from age 50 years). ICAO therefore recognizes the increase in cardiovascular risk with increasing age,
which is an observation made in many Contracting States. There are, however, differences between States
regarding the rate of increase in cardiovascular risk with increasing age.
In many Western States, the annual cardiovascular mortality for males reaches around 1 per cent per
annum at age 70 years, representing an increase in risk of about 100 times from that at age 30. Further,
the risk of developing other physical diseases such as cancer, diabetes and epilepsy is very low in young
adults, but increases with increasing age. On the other hand, mental health illness and behavioural
problems, including those related to drug and alcohol use, do not demonstrate such a steep gradient, and
in the general population these categories are usually more frequent than physical disease in younger age
groups. It therefore seems appropriate to consider the likely prevalence of different diseases in the pilot
population when considering the type of routine periodic examination they should undergo. Further, it is
widely accepted that illness in later life, both physical and mental, can be delayed or prevented by
lifestyle interventions (and medical treatment, if necessary) at an early stage, and professional pilots
represent a group of motivated individuals who have a keen interest in health maintenance. Consequently
a change in the emphasis of the medical examination of younger pilots toward preventive aspects will
encourage good health and, therefore, bring flight safety benefits later on in a pilot’s career.
The annual Class 1 medical examination is unlikely to reveal any significant physical problem in pilots
under 40 years, whilst with increasing age the incidence of physical disease generally increases. In
younger applicants, some items of the physical assessment could therefore be considered for omission in
alternate years without significant detriment to flight safety. This would permit additional time to be used
to focus on mental health aspects and on preventive aspects of physical health.
Recommendation 6.3.1.2.1 encourages licensing authorities, in alternate years, to omit certain items from
the physical examination in applicants under 40 years of age, in order for the medical examiner to spend
more time discussing medical issues, from an educational viewpoint, with an applicant in this age group.
However, a licensing authority may wish, for example, to undertake some evaluation of the vision every
year in order to identify those applicants who would benefit from correcting lenses, or a change in lens
prescription, since refractive error can change over time. Similarly body weight should in most applicants
be checked annually.
An examination of, for example, the heart and lungs, and checking the blood pressure and urine in all
pilots under 40 years, on an annual basis, may not be necessary – a two yearly examination should be
adequate. This does not preclude the licensing authority from requiring more frequent checks in those
who are known to have an increased risk. If the content of the physical examination is reduced in alternate
years, this releases some time for discussing aspects of health that may, in the longer term (i.e. with a
　
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