Medical certification of pilots.

This paper reviews some of the problems encountered in administering satisfactory medical requirements for professional pilots. The role of these requirements in the context of flight safety is discussed. The control of risk by the imposition of strict requirements is contrasted with that achieved by training designed to contain the risk introduced by incapacitation. The fact that aviation safety is based on acceptable risk levels is pointed out and the role of physician in this regard is discussed. The need for a widely accepted minimum level of fitness required for aviation duties is brought out. Certain operational aspects are touched upon. Medical requirements based on the desire to avoid on-duty incapacitation are contrasted with those designed to ensure adequate performance. The present ICAO cardiovascular requirement is discussed with particular reference to permanent grounding following myocardial infarction. The significance of inflight crew incapacitation training is pointed out and a plea for close cooperation between licensing authorities, airline operators, and pilots is made.