Cabin Crew Medical Report

MED.C.001
General

Cabin crew members shall only perform the duties and responsibilities required by aviation safety rules on an aircraft if they comply with the applicable requirements of this Part.

MED.C.005
Aeromedical assessments

1. Cabin crew members shall undergo aeromedical assessments to verify that they are free from any physical or mental illness which might lead to incapacitation or an inability to perform their assigned safety duties and responsibilities
2. Each cabin crew member shall undergo an aeromedical assessment before first being assigned to duties on an aircraft, and after that at intervals of maximum 60 months.

AMC1 MED.C.005
Aeromedical assessments

1. When conducting aeromedical examination and/or assessments of cabin crew, their medical fitness should be assessed with particular regard to their physical and mental ability to:
   1. undergo the training required for cabin crew to acquire and maintain competence, e.g. actual fire-fighting, slide descending, using Protective Breathing Equipment (PBE) in a simulated smoke-filled environment, providing first aid;
   2. manipulate the aircraft systems and emergency equipment to be used by cabin crew, e.g. cabin management systems, doors/exits, escape devices, fire extinguishers, taking also into account the type of aircraft operated e.g. narrow-bodied or wide-bodied, single/multi-deck, single/multi-crew operation;
   3. continuously sustain the aircraft environment whilst performing duties, e.g. altitude, pressure, re-circulated air, noise; and the type of operations such as short/medium/long/ultra long -haul; and
   4. perform the required duties and responsibilities efficiently during normal and abnormal operations, and in emergency situations and psychologically demanding circumstances e.g. assistance to crew members and passengers in case of decompression; stress management, decision-making, crowd control and effective crew coordination, management of disruptive passengers and of security threats. When relevant, operating as single cabin crew should also be taken into account when assessing the medical fitness of cabin crew.

UK GM1 MED.C.005
Aeromedical assessments

Applicants who meet the DVLA Medical Standards of Fitness to Drive for Group 1 driving may be assessed as having an acceptable risk of incapacitation, except as indicated in the UK AltMOCs and in the further guidance material below.

Cabin crew periodic medical assessments may be carried out no more than 45 days prior to the expiry date of the previous Medical Report and shall be valid for 60 months from that expiry date.

If the Medical Report has expired, the AME or OHMP need only carry out a periodic medical assessment.

MED.C.020
General

Cabin crew members shall be free from any:

1. abnormality, congenital or acquired;
2. active, latent, acute or chronic disease or disability;
3. wound, injury or sequelae from operation; and
4. effect or side-effect of any prescribed or non-prescribed therapeutic, diagnostic or preventive medication taken that would entail a degree of functional incapacity that might lead to incapacitation or an inability to discharge their safety duties and responsibilities.

MED.C.025
Content of aeromedical assessments

1. An initial aeromedical assessment shall include at least:
   1. an assessment of the applicant cabin crew member’s medical history; and
   2. a clinical examination of the following:
      1. cardiovascular system;
      2. respiratory system
      3. musculoskeletal system;
      4. otorhinolaryngology;
2. Each subsequent aero-medical assessment shall include
   1. an assessment of the cabin crew member’s medical history; and
   2. a clinical examination if deemed necessary in accordance with aero-medical best practice.
3. For the purpose of (a) and (b), in case of any doubt or if clinically indicated, a cabin crew member’s aeromedical assessment shall also include any additional medical examination, test or investigation that are considered necessary by the AME, AeMC or OHMP.

UK AltMOC1 MED.C.025
Content of aeromedical assessments

Aeromedical examinations and/or assessments of cabin crew members should be conducted according to the medical requirements in UK AltMOC2 to AMC18 MED.C.025:

1. An applicant should not have any established medical history or clinical diagnosis of any disease or disability, condition or disorder, acute or chronic, congenital or acquired, that would entail a degree of functional incapacity likely to lead to incapacitation or an inability to discharge their safety duties and responsibilities.

UK AltMOC2 MED.C.025
Cardiovascular system

1. Examination
   1. A standard 12-lead resting electrocardiogram (ECG) and report should be completed on clinical indication.
   2. Extended cardiovascular assessment should be required when clinically indicated.
2. Cardiovascular system - general
   1. Cabin crew members with any of the following conditions:
      1. aneurysm of the thoracic or supra-renal abdominal aorta, before surgery;
      2. significant functional abnormality of any of the heart valves;
      3. heart or heart/lung transplantation should be assessed as unfit. A fit assessment may be considered following satisfactory treatment and recovery.
   2. Cabin crew members with an established diagnosis of one of the following conditions:
      1. peripheral arterial disease before or after surgery;
      2. aneurysm of the abdominal aorta, before or after surgery;
      3. minor cardiac valvular abnormalities;
      4. after cardiac valve surgery;
      5. abnormality of the pericardium, myocardium or endocardium;
      6. congenital abnormality of the heart, before or after corrective surgery;
      7. a cardiovascular condition requiring systemic anticoagulant therapy;
      8. recurrent vasovagal syncope;
      9. arterial or venous thrombosis; or
      10. pulmonary embolism should be evaluated by a cardiologist before a fit assessment can be considered.
3. Blood pressure
   Blood pressure should be recorded at the initial examination.
   1. The blood pressure should be within normal limits.
   2. The initiation of medication for the control of blood pressure should require a period of temporary suspension of fitness to establish the absence of any significant side effects.
4. Coronary artery disease
   1. Cabin crew members with:
      1. cardiac ischaemia;
      2. symptomatic coronary artery disease should be assessed as unfit. A fit assessment may be considered following satisfactory treatment and recovery.
   2. Cabin crew members who are asymptomatic after myocardial infarction or surgery for coronary artery disease should have fully recovered before a fit assessment can be considered.
5. Rhythm/conduction disturbances
   1. Cabin crew members with any significant disturbance of cardiac conduction or rhythm should undergo cardiological evaluation before a fit assessment can be considered.
   2. Cabin crew members with a history of:
      1. ablation therapy; or
      2. pacemaker implantation should undergo satisfactory cardiovascular evaluation before a fit assessment can be made.
   3. Cabin crew members with:
      1. symptomatic sinoatrial disease;
      2. complete atrioventricular block;
      3. symptomatic QT prolongation;
      4. an automatic implantable defibrillating system; or
      5. a ventricular anti-tachycardia pacemaker
         should be assessed as unfit.

UK AltMOC3 MED.C.025
Respiratory system

1. Cabin crew members with significant impairment of pulmonary function should be assessed as unfit. A fit assessment may be considered once pulmonary function has recovered and is satisfactory.
2. Cabin crew members should be required to undergo pulmonary function tests on clinical indication.
3. Cabin crew members with a history or established diagnosis of:
   1. asthma;
   2. active inflammatory disease of the respiratory system;
   3. active sarcoidosis;
   4. pneumothorax;
   5. sleep apnoea syndrome/sleep disorder; or
   6. major thoracic surgery should undergo respiratory evaluation with a satisfactory result before a fit assessment can be considered.

UK AltMOC4 MED.C.025
Digestive system

1. Cabin crew members with any sequelae of disease or surgical intervention in any part of the digestive tract or its adnexa likely to cause incapacitation in flight, in particular any obstruction due to stricture or compression, should be assessed as unfit.
   A fit assessment may be considered following satisfactory treatment and recovery.
2. Cabin crew members should be free from herniae that might give rise to incapacitating symptoms.
3. Cabin crew members with disorders of the gastro-intestinal system, including:
   1. recurrent dyspeptic disorder requiring medication;
   2. pancreatitis;
   3. symptomatic gallstones;
   4. an established diagnosis or history of chronic inflammatory bowel disease; or
   5. after surgical operation on the digestive tract or its adnexa, including surgery involving total or partial excision or a diversion of any of these organs may be assessed as fit subject to satisfactory evaluation after successful treatment and full recovery after surgery.

UK AltMOC5 MED.C.025
Metabolic and endocrine systems

1. Cabin crew members should not possess any functional or structural metabolic, nutritional or endocrine disorder which is likely to interfere with the safe exercise of their duties and responsibilities.
2. Cabin crew members with metabolic, nutritional or endocrine dysfunction may be assessed as fit, subject to demonstrated stability of the condition and satisfactory aero-medical evaluation.
3. Diabetes mellitus
   1. Cabin crew members with diabetes mellitus requiring insulin may be assessed as fit if it can be demonstrated that adequate blood sugar control has been achieved and hypoglycaemia awareness is established and maintained. Limitations should be imposed as appropriate.
   2. Cabin crew members with diabetes mellitus not requiring insulin may be assessed as fit if it can be demonstrated that adequate blood sugar control has been achieved and hypoglycaemia awareness, if applicable considering the medication, is achieved.

UK AltMOC6 MED.C.025
Haematology

Cabin crew members with a haematological condition, such as:

1. abnormal haemoglobin including, but not limited to, anaemia, polycythaemia or haemoglobinopathy;
2. coagulation, haemorrhagic or thrombotic disorder;
3. significant lymphatic enlargement;
4. acute or chronic leukaemia; or
5. enlargement of the spleen may be assessed as fit subject to satisfactory aero-medical evaluation.

UK AltMOC7 MED.C.025
Genitourinary system

1. Urine analysis should form part of the initial aero-medical examination. The urine should not contain any abnormal element(s) considered to be of pathological significance.
2. Cabin crew members with any sequelae of disease or surgical procedures on the kidneys or the urinary tract, in particular any obstruction due to stricture or compression likely to cause incapacitation, should be assessed as unfit.
   A fit assessment may be considered following satisfactory treatment and recovery.
3. Cabin crew members with a genitourinary disorder, such as:
   1. renal disease; or
   2. a history of renal colic due to one or more urinary calculi may be assessed as fit subject to satisfactory renal/urological evaluation.
4. Cabin crew members who have undergone a major surgical operation in the urinary apparatus involving a total or partial excision or a diversion of its organs should be assessed as unfit and be re-assessed after full recovery before a fit assessment can be made.

UK AltMOC8 MED.C.025
Infectious disease

Cabin crew members who are HIV positive may be assessed as fit if investigation provides no evidence of clinical disease and subject to satisfactory aero-medical evaluation.

UK AltMOC9 MED.C.025
Obstetrics and gynaecology

1. Cabin crew members who have undergone a major gynaecological operation should be assessed as unfit until full recovery.
2. Pregnancy:
   A pregnant cabin crew member should be assessed as unfit when they are no longer able to safely carry out their duties.

UK AltMOC10 MED.C.025
Musculoskeletal system

1. A cabin crew member should have sufficient standing height, arm and leg length and muscular strength for the safe exercise of their duties and responsibilities.
2. A cabin crew member should have satisfactory functional use of the musculoskeletal system

UK AltMOC11 MED.C.025
Psychiatry

1. Cabin crew members with a mental or behavioural disorder due to alcohol or other problematic substance use should be assessed as unfit pending recovery and freedom from problematic substance use and subject to satisfactory psychiatric evaluation.
2. Cabin crew members with an established history or clinical diagnosis of schizophrenia, schizotypal or delusional disorder should be assessed as unfit.
3. Cabin crew members with a psychiatric condition such as:
   1. mood disorder;
   2. neurotic disorder;
   3. personality disorder; or
   4. mental or behavioural disorder should undergo satisfactory aeromedical evaluation before a fit assessment can be made.
4. Cabin crew members with a history of a single or repeated acts of deliberate self-harm should be assessed as unfit. Cabin crew members should undergo satisfactory aeromedical evaluation including reports from their treating clinician(s) before a fit assessment can be considered.

UK AltMOC12 MED.C.025
Psychology

Cabin crew members with an established diagnosis of a psychological disorder may be assessed as fit subject to satisfactory aero-medical evaluation.

UK AltMOC13 MED.C.025
Neurology

1. Cabin crew members with an established history or clinical diagnosis of:
   1. Epilepsy; or
   2. recurring episodes of disturbance of consciousness of uncertain cause should be assessed as unfit. A fit assessment may be considered following satisfactory evaluation.
2. Cabin crew members with an established history or clinical diagnosis of epileptiform EEG abnormalities and focal slow waves may be assessed as fit subject to satisfactory aero-medical evaluation.
3. Cabin crew members with an established history or clinical diagnosis of:
   1. progressive or non-progressive disease of the nervous system;
   2. a single episode of disturbance of consciousness of uncertain cause;
   3. loss of consciousness after head injury;
   4. penetrating brain injury; or
   5. spinal or peripheral nerve injury should undergo further evaluation before a fit assessment can be considered.

UK AltMOC14 MED.C.025
Visual system

1. Examination:
   1. a routine eye examination should form part of the initial examination; and
   2. an extended eye examination should be undertaken when clinically indicated.
2. Distant visual acuity with both eyes, with or without correction, should be 6/9 or better.
3. A cabin crew member should be able to read an N5 chart (or equivalent) at 30–50 cm, with or without correction.
4. Cabin crew members should have normal fields of vision.
5. Cabin crew members who have undergone refractive surgery may be assessed as fit subject to satisfactory ophthalmic evaluation.
6. Cabin crew members with diplopia should be assessed as unfit.
7. Spectacles and contact lenses:
   If satisfactory visual function is achieved only with the use of correction:
   1. In the case of myopia or hypermetropia, spectacles or contact lenses should be worn whilst on duty;
   2. in the case of presbyopia, spectacles or contact lenses should be readily available for immediate use whilst on duty;
   3. the correction should provide optimal visual function and be well tolerated;
   4. orthokeratologic lenses should not be used.

UK AltMOC15 MED.C.025
Colour vision

Cabin crew members should be able to correctly identify 9 of the first 15 plates of the 24-plate edition of Ishihara pseudoisochromatic plates. Alternatively, cabin crew members should demonstrate that they are colour safe.

UK AltMOC16 MED.C.025
Otorhinolaryngology

1. Hearing should be satisfactory for the safe exercise of cabin crew duties and responsibilities.
2. Examination:
   1. An ear, nose and throat (ENT) examination should form part of the initial examination.
   2. Hearing: the cabin crew member should understand correctly conversational speech when tested with each ear at a distance of 2 meters from and with the cabin crew member’s back turned towards the examiner. Cabin crew with hypoacusis should be investigated and the aeromedical assessment should include demonstration of satisfactory functional hearing abilities.
3. Cabin crew members with:
   1. an active pathological process, acute or chronic, of the internal or middle ear;
   2. unhealed perforation or dysfunction of the tympanic membrane(s);
   3. disturbance of vestibular function;
   4. significant restriction of the nasal passages;
   5. sinus dysfunction;
   6. significant malformation or significant, acute or chronic infection of the oral cavity or upper respiratory tract;
   7. significant disorder of speech or voice should undergo further medical examination and assessment to establish that the condition does not interfere with the safe exercise of their duties and responsibilities.

UK AltMOC17 MED.C.025
Dermatology

In cases where a dermatological condition is associated with a systemic illness, full consideration should be given to the underlying illness before a fit assessment may be made.

UK AltMOC18 MED.C.025
Oncology

1. After treatment for malignant disease, cabin crew members should undergo satisfactory oncological and aero-medical evaluation before a fit assessment may be considered.
2. Cabin crew members with an established history or clinical diagnosis of intra-cerebral malignant tumour should be assessed as unfit. Considering the histology of the tumour, a fit assessment may be considered after successful treatment and full recovery.

UK GM1 MED.C.025
Content of aeromedical assessments

A specimen questionnaire that could be used for the initial medical assessment is attached at Appendix A.

UK GM2 MED.C.025
Respiratory system

Applicants with impaired pulmonary function e.g. due to COPD, may require additional assessment such as hypoxic challenge testing or functional assessment during flight.

Pneumothorax.
Applicants may be assessed as fit:

• Six weeks after recovery from a single spontaneous pneumothorax
• Following definitive surgical treatment for recurrent pneumothorax
• On recovery (full absorption) from traumatic pneumothorax

UK GM3 MED.C.025
Metabolic and endocrine systems

Cabin crew members with diabetes must be under regular review. Cabin crew members treated with insulin or oral medication with a potential for hypoglycaemia should have a requirement to undergo specific regular medical examinations or assessments (SIC).

Cabin crew members with diabetes mellitus requiring insulin:

• must have adequate awareness of hypoglycaemia
• must not have had more than one episode of hypoglycaemia requiring the assistance of another person in the preceding 12 months
• must have blood glucose monitoring no more than 2 hours before the start of the duty period and every 2 hours while on duty.

Cabin crew members with diabetes mellitus not requiring insulin must not have had more than one episode of hypoglycaemia requiring the assistance of another person within the preceding 12 months. It may be appropriate to monitor blood at times relevant to flying duties to enable the detection of hypoglycaemia.

UK GM4 MED.C.025
Obstetrics and gynaecology

Following pregnancy, the AME, AeMC or OHMP shall assess the medical fitness of the cabin crew member and decide whether she is fit to resume her safety duties.

UK GM5 MED.C.025
Neurology

Cabin crew members who have a first unprovoked seizure should be assessed as unfit. A fit assessment may be considered 6 months after the date of the seizure, or 12 months after the date of the seizure if there are clinical factors or investigation results which suggest an unacceptably high risk of a further seizure, i.e. 20% or greater per annum.

Cabin crew members who have a history or diagnosis of epilepsy may be assessed as fit provided that they have been free from any unprovoked seizure for a minimum of one year from the date of the assessment (on or off treatment).

They must be under regular review and should have a requirement to undergo specific regular medical examinations or assessments (SIC).

UK GM6 MED.C.025
Visual system

Visual acuity should be assessed with both eyes open, or in the only eye if monocular.

UK GM7 MED.C.025
Colour vision

Suitable functional tests would include the successful completion of Safety Equipment & Procedures (SEP) training.

UK GM8 MED.C.025
Otorhinolaryngology

Cabin crew with hypoacusis should demonstrate satisfactory functional hearing abilities, either by a clinical test such as the forced whisper test, or a functional test such as satisfactory completion of Safety Equipment and Procedures (SEP) training.

Applicants with a history of recurrent otitis media or recurrent sinusitis may require assessment by an ENT specialist.

UK GM9 MED.C.025
Subsequent aeromedical assessment

A specimen questionnaire that could be used for periodic medical assessment is attached at Appendix B.

MED.C.030
Cabin crew medical report

1. After completion of each aero-medical assessment, applicants for, and holders of, a cabin crew attestation:
   1. shall be provided with a cabin crew medical report by the AME, AeMC or OHMP; and
   2. shall provide the related information, or a copy of their cabin crew medical report to the operator(s) employing their services.
2. Cabin crew medical report
   A cabin crew medical report shall indicate the date of the aeromedical assessment, whether the cabin crew member has been assessed fit or unfit, the date of the next required aeromedical assessment and, if applicable, any limitation(s). Any other elements shall be subject to medical confidentiality in accordance with MED.A.015.

MED.C.035
Limitations

1. If holders of a cabin crew attestation do not fully comply with the medical requirements specified in Section 2, the AME, AeMC or OHMP shall consider whether they may be able to perform cabin crew duties safely if complying with one or more limitations.
2. Any limitation(s) to the exercise of the privileges granted by the cabin crew attestation shall be specified on the cabin crew medical report and shall only be removed by an AME, AeMC or by an OHMP in consultation with an AME.

AMC1 MED.C.030
Cabin crew medical report

1. Cabin crew medical report
   The medical report to be provided in writing to the applicants for, and holders of, a cabin crew attestation after completion of each aeromedical examination and/or assessment should be issued:
   1. in the national language(s) and/or in English; and
   2. according to the format below, or another format if all, and only the elements specified below are provided:

Specimen Cabin Crew Medical Report

AMC1 MED.C.035
Limitations

1. When assessing whether the holder of a cabin crew attestation may be able to perform cabin crew duties safely if complying with one or more limitations, the following possible limitations should be considered:
   1. a restriction to operate only in multi- cabin crew operations (MCL);
   2. a restriction to specified aircraft type(s) (OAL) or to a specified type of operation (OOL);
   3. a requirement to undergo the next aeromedical examination and/or assessment at an earlier date than required by MED.C.005 (b) (TML);
   4. a requirement to undergo specific regular medical examination(s) or assessments (SIC);
   5. a requirement for visual correction (CVL), or by means of corrective lens only (CCL);
   6. a requirement to use hearing aids (HAL); and
   7. special restriction as specified (SSL).

UK GM1 MED.C.035
Limitations

An AME or OHMP may add or remove any of the specified limitations.

There is likely to be little indication for the MCL limitation. You should discuss the case with the AMS before applying this limitation to a UK member of cabin crew.

There is likely to be little indication for the OAL and OOL limitations. You should discuss the case with the AMS before applying this limitation to a UK member of cabin crew.

The TML limitation may be used for applicants who require review of their fitness at an interval less than that specified at MED.C.005. You should annotate your report to indicate the period of validity: 'Valid for ……. months.'

The SIC limitation may be used for applicants who have a medical condition which requires regular review of their fitness at an interval less than that specified at MED.C.005. You should annotate your report to indicate the period of validity: 'Valid for …….months/years.'

Used for applicants who can only meet the requirements of UK AltMOC14 MED.C.025 by using visual correction. The CVL limitation should be used for all UK crew who require visual correction, including contact lens wearers.

Used for applicants who can only meet the requirements of UK AltMOC16 MED.C.025 by wearing a hearing aid(s).

You should discuss the case with the AMS before applying this limitation to a UK member of cabin crew.