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12.4 CASA's approach to aeromedical risk assessment for clinical problems other than excluded medical conditions
DAME's must assess a Class 2 applicant in accordance with CASR Part 67. If an applicant fails to meet the Class 2 medical standard, further consideration may be possible under the flexibility provision in CASR 67.180 (2)(e)(ii), where having taken into account the result of the examination, the extent to which the standard is not met is not likely to endanger the safety of air navigation.
If a medical condition or clinical issue (other than an excluded medical condition) is identified during a medical examination, the next step is to conduct an aeromedical risk assessment.
An aeromedical risk assessment requires investigation of the following:
- the nature and extent of the medical condition itself
- the medical treatment for such a condition
- the stability of the condition for the duration of the Class 2 medical certificate if one were to be issued
- the likelihood of a medical event occurring that could affect aviation safety (an aviation event), taking into account, in particular:
- the effect of aviation on the condition (for example, low pressure, lack of oxygen, jet lag and long hours)
- the effect of the condition on aviation (for example, the loss of sight in 1 eye affects the ability to undertake a visual scan). Each of these aspects can be individually risk-managed by consideration of the likelihood (mainly clinical) and consequences (mainly operational) of an aviation event occurring.
The mitigations might include any of the following:
- definitive treatment (eg cardiac ablation, appendicectomy)
- maintenance therapy (antihypertensives, steroid inhalers)
- conditions and restrictions on the Class 2 medical certificate.
Operational limitations and restrictions, designed to mitigate risk, may be imposed by the DAME delegate as conditions on the Class 2 medical certificate.
In the operational setting examples of such operational limitations and restrictions might include requirements for one or more of the following:
- no passengers
- an additional pilot
- local flying only
- no flying over built up areas.
When safety relevant medical problems are identified, the DAME must actively consider whether to impose operational limitations and restrictions in the form of conditions on a Class 2 medical certificate. Where aeromedical risk of a safety-relevant medical problem is not mitigated by conditions or restrictions, the application must be referred to CASA.
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