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Grounding, DAME consultation and CASA notification
This guideline provides guidance about conditions where a pilot/controller should consult a DAME and when to notify CASA about a medical condition.
Certificate holders' obligations
Pilots/controllers are required to ground themselves if:
- they develop a medically significant condition,
- their condition impairs their ability to use their licence, or
- there is a change to their condition or treatment,
until cleared by a DAME or CASA AvMed to return to flying/controlling.
This includes any adjustments in medication dose or commencement of new medications, to ensure that there are no unforeseen side effects. (Refer to the Civil Aviation Safety Regulations 1998 (CASR) Part 67.265).
The regulations do not specifically list those conditions which are considered medically significant and safety-relevant. The definition of "medically significant conditions" and "safety-relevant" provide guidance as to the sorts of conditions that require grounding and notification to CASA.
The definition of medically significant condition is described in the regulations as:
Regulation 67.010: medically significant condition includes:
- (a) any of the following (no matter how minor):
- (i) any illness or injury;
- (ii) any bodily infirmity, defect or incapacity;
- (iii) any mental infirmity, defect or incapacity;
- (iv) any sequela of an illness, injury, infirmity, defect or incapacity mentioned in subparagraph (i), (ii) or (iii); and
- (b) any abnormal psychological state; and
- (c) drug addiction and drug dependence; and
- (d) for a woman—pregnancy and the physiological and psychological consequences of pregnancy or of termination of pregnancy.
Regulation 67.015: Meaning of safety-relevant
The definition of safety-relevant contained in the CASR is broad:
For the purposes of this Part, a medically significant condition is safety-relevant if it reduces, or is likely to reduce, the ability of someone who has it to exercise a privilege conferred or to be conferred, or perform a duty imposed or to be imposed, by a licence that he or she holds or has applied for.
When CASA notification is not usually required
Pilots/controllers should consult a DAME, but are not required to notify CASA AvMed about common, minor, self-limiting conditions which resolve within the permitted timeframes stipulated in When should CASA be notified? for example:
- Influenza, coryza (irritation and inflammation of the mucous membrane inside the nose) or other upper respiratory tract infection
- Cough in the absence of wheezing
- Occasional, mild headaches
- Uncomplicated urinary tract infection
- Uncomplicated haemorrhoid(s) if not bleeding and requiring only symptomatic treatment
- Mild allergic rhinitis (hayfever), if no nasal blockage present and no antihistamine treatment required
- Minor soft tissue injuries without residual pain
- Muscular pain of short duration not requiring long-term medication and not related to any significant underlying chronic illness
- Dysmenorrhoea (period pain)
- Dental extractions
A DAME can return a pilot/controller to duty once they are satisfied the condition has fully resolved without sequelae, and if relevant, there are no adverse effects from medication or treatment.
What should CASA be notified about?
CASA AvMed must be notified about conditions that are universally medically significant and safety relevant, for example:
- Coronary heart disease that has required treatment or, if untreated, that has been symptomatic or clinically significant
- Heart valve replacement
- Heart transplant
- Heart Attack (Myocardial infarction)
- Permanent cardiac pacemaker
- Abnormal cardiac rhythm requiring medical attention
- Diabetes mellitus requiring insulin or other hypoglycemic medication
- Disturbance of consciousness without satisfactory medical explanation of the cause
- Transient loss of control of nervous system function(s) without satisfactory medical explanation of cause.
- Traumatic brain injury
- Bipolar disorder
- Personality disorder that is severe enough to have repeatedly manifested itself by overt acts
- Any psychiatric condition requiring psychotropic medication or hospital admission
- Illicit Substance abuse and dependence
- Any incident or accident related to alcohol or other drugs
- Any condition treated with psychotropic medication or narcotic medication
This list is not intended to be complete and requires a DAME's clinical judgement of the specific circumstances of a particular condition in the context of the certificate holder's other medical history and occupation.
When should CASA be notified?
In accordance with the regulations, medical certificate holders have an obligation to notify CASA or a DAME about any medical significant changes in their medical condition: (CASR Part 67.265)
- Class 1 Medical Certificate holders - any condition continuing longer than 7 days
- Class 2 Medical Certificate holders - any condition continuing for longer than 30 days
- Basic Class 2 Medical Certificate holders - any condition continuing for longer than 30 days
- Class 3 Medical Certificate holders - any condition continuing for longer than 30 days.
If the holder of a medical certificate tells a DAME about a medically significant condition, and the condition is safety-relevant, the DAME must notify CASA in writing within 5 working days (CASR Part 67.125)
What to do if there is doubt?
If there is doubt about whether a medical condition is safety relevant, or if CASA needs to be notified, AvMed should be contacted for further advice.
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The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.