1、ICAO 13984 f* m 4841416 0036862 437 m Dot 8984-AN/895 Manual of Civil Aviation Medicine SECOND EDITION - 1985 Approved by the Secretary General and published under his authority 1985 INTERNATIONAL CIVIL AVIATION ORGANIZATION . Copyright International Civil Aviation Organization Provided by IHS under
2、 license with ICAONot for ResaleNo reproduction or networking permitted without license from IHS-,-ICAO 8984 * m 48414Lb 001bi363 373 - Published in separate English, French, Russian and Spanish editions by the International Civil Aviation Organization. All cqrrespondence, except orders-and subscrip
3、tions, should be addressed to the Secretary General. Orders for this publication should be sent to one of the following addresses, togetheiwith the appropriate remittance (by bank draft or post office money order) in U.S. dollars or the currency of the country in which the order is placed. Document
4、Sales Unit . International Civil Aviation Organization 1000 Sherbrooke Street West, Suite 400 Montreal, Quebec Canada H3A 2R2 Argentina. El Ateneo, Pedro Garcia S.A.L.E. e I., Dpto. Compras - Importation, Patagones 2463, 1282 Buenos Aires. Egypt. ICAO Representative, Middle East and Eastern African
5、Office, 16 Hassan Sabri, Zamalek, Cairo. France. Representant de IOACI, Bureau Europe, 3 U.S. $20.00 (air mail). Copyright International Civil Aviation Organization Provided by IHS under license with ICAONot for ResaleNo reproduction or networking permitted without license from IHS-,-ICAO 8984 tt m
6、48411436 00368b4 20T - Manual of Civil Aviation Medicine SECOND EDITION - 1985 Copyright International Civil Aviation Organization Provided by IHS under license with ICAONot for ResaleNo reproduction or networking permitted without license from IHS-,-_ - AMENDMENTS The issue of amendments is announc
7、ed in the ICAO Bulletin and in the monthly supplements to the Catalogue of ICAO Publications, which holders of this publication should consult. These amendments are available free upon request. NO. I Date I Entered by I Date Entered by r . . . . .- Copyright International Civil Aviation Organization
8、 Provided by IHS under license with ICAONot for ResaleNo reproduction or networking permitted without license from IHS-,-ICAO 8984 *ict - 484L4Lb OOLbdbb 082 m FOREWORD The Personnel/Training/Medical (PEL/TRG/MED) 1970 Divisional Meeting considered that availability of suitable medical guidance mate
9、rial was of paramount importance to the uniform application of the Standards and Rec- ommended Practices (SARPs) in Annex 1, as well as in such fast-moving fields as accident investigation and human factors in aviation. The meeting also recommended that action be taken to provide expert advice to th
10、e Secretariat in support of the preparation of such medical guidance material. In line with the Air Navigation Commissions (standing technical body of ICAO) desires, a small Medical Study Group was established for the purpose of assisting the Secretariat in preparing the necessary material. The firs
11、t edition of the ICAO Manual of Civil Aviation Medicine (Medical Manual), published in 1974, was essentially the result of this work. Inevitably, since that time, advances have been made in medical science generally. Assistance and advice have been provided by aviation medical specialists from many
12、Contracting States, and their valuable contributions have enabled this second edition of the Medical Manual to reflect those advances as they apply to civil aviation medicine in particular. In addition, many excellent comprehensive textbooks and published studies on aviation and space medicine are n
13、ow available in world literature. This edition is intended to complement existing texts by emphasizing the clinical problems encountered in medical licensing in civil aviation. It is designed for the experienced designated medical examiner, and for the aviation medical expert, to aid in the approach
14、 and management of intricate borderline cases. Just as the development and enforcement of standards for medical assessment of civil aviation personnel on an international basis is fraught with numerous difficulties, so is the compilation of a suitable current general medical manual complicated by th
15、e heterogeneous nature and economic factors involved. There are bound to be certain omissions and particular stress made on other important aspects in an attempt to comprise and achieve a measure of international uniformity. The guidance material dealing with medical assessment is intended for the u
16、se of medical examiners at the dis- cretion of the Licensing Authorities. The discussion of the application of SARPs is, however, couched in terms intended to assist the Licensing Authority in the implemen- tation of the medical standards. When making a medical assessment, the relevant operating env
17、ironment should be borne in mind. Appli- cants engaged in single pilot operations clearly require the most careful medical evaluation in order to avoid incapaci- tation. Those engaged in multicrew operations, where there has been effective incapacitation training, may be con- sidered less stringentl
18、y at the discretion of the Licensing Authority. In such circumstances it may be appropriate to issue an operational limitation to the licence in the case of flight crew with non-critical medical conditions. When consulting the Medical Manual it should be remembered that it is intended as guidance ma
19、terial only and as such has no regulatory status. Its users should, whenever in doubt, always make reference to the text of the current edition of Annex 1 for up-to-date information on SARPs. While Contracting States issue licences for civil aviation purposes in accordance with their national civil
20、aviation regulations, these regulations are normally based upon the SARPs contained in Annex 1 to the Chicago Convention (1944), which specifies minimum standards only. Thus an individual Contracting State may have regulations ad- ditional to those specified in Annex 1 for some reason particular to
21、that State. Furthermore, the requirements published under any national regulations are the legal requirements of that State, regardless of what may be found in Annex 1. The main purpose of the Medical Manual is to assist and guide designated medical examiners and Licensing Auth- orities in decisions
22、 relating to the medical fitness of licence applicants as specified in Annex 1. It is, however, envis- aged that the manual might also be useful to supplement properly supervised theoretical and practical post-graduate training in aviation medicine. Thus a tentative outline for a one-week post-gradu
23、ate course for prospective des- ignated aviation medical examiners has been included. (iii) Copyright International Civil Aviation Organization Provided by IHS under license with ICAONot for ResaleNo reproduction or networking permitted without license from IHS-,-(iv) - - - _ ICAO 898q tt - 48YlqLb
24、0036867 TL9 - In this second edition of the Medical Manual, some limitation of contents has been necessary. The scope of the material includes, particularly, guidance on those areas in which difficulties have been experienced by Contracting States. To allow for the incorporation of guidance material
25、 in other clinical fields for which provisions are specified in Manual of Civil Aviation Medicine Annex 1, as well as information on continuous medical developments related to aeronautical activities, a loose-leaf format has been adopted. States are invited to assist in improving this manual by subm
26、itting comments to the Organization and by suggest- ing any pertinent additional information which might usefully be included. Copyright International Civil Aviation Organization Provided by IHS under license with ICAONot for ResaleNo reproduction or networking permitted without license from IHS-,-I
27、CAO 8984 t* - 48414Lb OOLbl!bi! 955 - TABLE OF CONTENTS PART I. LICENSING PRACTICES Chapter 1. Rules concerning licences . I-l-l Chapter 2. Medicalrequirements . I-2-1 PART II. AVIATION PHYSIOLOGY Chapter 1. Physiological factors of relevance to flight safety II-l-1 Chapter 2. Flight crew incapacita
28、tion. 11-2-l PART III. MEDICAL ASSESSMENT Chapter 1. Cardiovascular system . . . Chapter 2. Respiratory system Chapter 3. Digestive system Chapter 4. Metabolic nutritional and endocrine diseases . Chapter 5. Haematology . Chapter 6. Urinary system . Chapter 7. Gynaecology and obstetrics Chapter 8. L
29、ocomotor system Chapter 9. Mental fitness and neurological examination . Chapter 10. Ophthalmology . Chapter 11. Oto-rhino-laryngology . Chapter 12. Health hazards and diseases in tropical areas . Chapter 13. Hazards of medication and drugs Chapter 14. Additional considerations reIated to air traffi
30、c control officers . PART IV. AVIATION PATHOLOGY Chapter 1. Medical factors in aircraft accident investigation and prevention . . . . , , . . . . . . . . . . . . . . . . . PART V. AVIATION MEDICAL TRAINING Chapter 1. Aeromedical training for designated medical examiners Chapter 2. Aviation operation
31、al training for designated medical examiners. Chapter 3. Medical facts for pilots. _. . - (vl Page 111-1-l 111-2-l 111-3-I 111-4-l III-5-l III-6-l 111-7-l 111-8-l 111-9-l 111-10-l III-1 l-l 111-12-l 111-13-l 111-14-l IV-l-1 V-l-i v-2-1 v-3-1 7 - i ; -I -.; Copyright International Civil Aviation Orga
32、nization Provided by IHS under license with ICAONot for ResaleNo reproduction or networking permitted without license from IHS-,-MANUAL OF CIVIL AVIATION MEDICINE Part I Licensing Practices . Copyright International Civil Aviation Organization Provided by IHS under license with ICAONot for ResaleNo
33、reproduction or networking permitted without license from IHS-,-ICAO 8984 *(% = 484343b 001btl70 503 W FART I Chapter 1. RULES CONCERNING LICENCES Page Page Introduction . The Chicago Convention . Personnel licensing. General . . The concept of licensing . Different types of licences - Pilots licenc
34、es . - Ratings for pilot licences - Licences for flight crew members other than pilot - Licences for personnel other than flight crew members The issue of a licence - Prerequisites . - Training . I-l-l I-l-l I-l-l I-l-l I-l-2 I-l-2 I-l-2 I-l-2 I-1-3 I-l-3 I-1-3 I-l-3 I-l-3 - Demonstration of compete
35、ncy. . - Currency of licences Regulations in medical licensing . The designated medical examiner Applicants medical history. The medical examination. Flexibility Evidence of medical fitness. Currency of Medical Assessment Decrease in medical fitness . Other medical regulations in the Annexes . Use o
36、f intoxicating liquor, narcotics and drugs Flight crew fatigue and fitness Use of oxygen in flight Definitions I-l-3 I-l-3 I-l-3 I-l-4 I-l-4 I-l-4 I-l-4 I-l-4 l-l-5 I-l-5 I-l-5 I-l-5 I-l-5 I-l-6 I-l-6 Copyright International Civil Aviation Organization Provided by IHS under license with ICAONot for
37、ResaleNo reproduction or networking permitted without license from IHS-,-ICAO 8984 I* W 484/4lb 003b8711 44T - Chapter 1. RULES CONCERNING LICENCES INTRODUCTION The Chicago Convention The Convention on International Civil Aviation, which was signed in Chicago on 7 December 1944, includes several art
38、icles which call for adoption of international reguIations in all fields where uniformity facilitates and improves air navigation. These regulations, known as Standards and Rec- ommended Practices (SARPs) have been promulgated in Annexes to the Convention which are amended from time to time when nec
39、essary. Each Annex deals with a specific aspect of international civil aviation. Aviation medicine is included mainly in Annex 1 (Personnel Licensing) and to some degree in Annex 2 (RuIes of the Air) and Annex 6 (Operation of Aircraft). Standards and Recommended Practices are defined as follows: Sta
40、ndard. Any specification for physical characteristics, configuration, materiel, performance, personnel or procedure, the uniform application of which is recognized as necessary for the safety or regularity of international air navigation, and to which Contracting States will conform in accordance wi
41、th the Convention. In the event of impossibility of compliance, notification to the Council of ICAO is compulsory under Article 38. Recommended Practice. Any specification for physical characteristics, configuration, materiel, performance, personnel or procedure, the uniform application of which is
42、recognized as desirable in the interest of safety, regularity or efficiency of international air navigation, and to which Contracting States will endeavour to conform in accord- ance with the Convention. Although the purpose of SARPs is to provide provisions only for international air navigation, th
43、ey have greatly influenced national regulations governing domestic aviation in most Contracting States. ICAO also originates guidance material which is intended to assist States in the implementation of SARPs, but places no regulatory responsibility upon States for compliance. The ICAO Manual of Civ
44、il Aviation Medicine falls into this category since it offers guidance on the implementation of the SARPs contained in Annex 1. PERSONNEL LICXNSING General Civil aviation includes different types of operations which, for convenience, can be divided into three major categories. Commercial air transpo
45、rt (airlines). This category includes all the operations conducted by large and sophis- ticated aircraft which are usually piloted by several crew members. In recent years the need for more efficiency has produced some dramatic technological changes which directly involve flight personnel: - In the
46、early 1960s, the typical crew on the flight deck of an airliner consisted of five members (two piiots, a flight engineer, a flight navigator and a flight radio operator). It now consists of two or three members, depending on the type of aircraft. - The tasks of the flight crew are changing. On moder
47、n aeroplane) Airtine transport pilot hcence - aeroptane (ATPL - aeroplane). The most senior pilot licence, permitting the holder to operate any aircraft either as pilot-in- command or co-pilot. The privileges of the instrument rating are included in the ATPL - aeroplane. j) Airtine transport pilot l
48、icence - helicopter (ATPL - helicopter). The helicopter equivalent of the ATPL - aeroplane. The instrument rating privileges, however, are not included in the licence. The CPL, SCPL and ATPL are often referred to as professional licences. Ratings for pilot licences a) Type and class ratings. Each pi
49、lot licence must be endorsed with a rating specifying the aircraft the holder is authorized to fly. The larger aircraft (usually those with a maximum take-off mass of more than 5 700 kg) need a specific rating. The smallest aircraft are grouped into classes (single-engine and multi-engine) and the holder of a licence endorsed with a class rating is permitted to fly a
