OFFICIAL - SENSITIVE - MEDICAL (WHEN COMPLETE)
CONDITIONS REQUIRING MEDICAL ASSESSMENT FOR VGS GLIDING/AEF FLYING
TO COMPLETE TICK RESPONSE Y/N
CONDITION OR EVENT / Y/N / IF YES / COMMENTS - FURTHER GUIDANCE
Recent immunisations or blood donation / No / Yes / DO NOT FLY WITHIN 24HRS OF TREATMENT / Compatible with RA2135
Acute illness (or flare of chronic condition) or new treatment / No / Yes / DO NOT FLY UNTIL RECOVERED / Compatible with RA2135
Acute injury limiting mobility or use of limbs / No / Yes / DO NOT FLY UNTIL RECOVERED / Unnecessary risk, limiting emergency drills.
ENT or sinus conditions / No / Yes / DO NOT FLY UNTIL RECOVERED / Cadets are to be able to safely tolerate barometric changes.
Pregnancy / No / Yes / DO NOT FLY / Probably safe but risks blame for any subsequent miscarriage. Serving aircrew grounded iaw AP1269A Lflt 5-162. Risk assessment in JSP 950 6-7-5 Annex J Appendix 1
Any condition that requires oxygen therapy / No / Yes / DO NOT FLY / Adverse effect of altitude. Integration of medical eqpt into cockpit. CAA Guidelines
Unstable or brittle medical condition / No / Yes / DO NOT FLY / Unreasonable to fly anyone with a predictable risk of incapacitation within the timescale of flight (or symptoms brought on by stressors of flight)
Limited exercise capacity/tolerance due to chest (heart or lung) illness or disease / No / Yes / DO NOT FLY / The most practical fitness to fly test for heart/lung disease is to assess whether the patient can walk 50 yards/metres at a normal pace or climb one flight of stairs without severe breathlessness. If this can be accomplished, it is likely that the patient will tolerate the normal aircraft environment. (CAA)
Fits, faints, blackouts (including epilepsy) / No / Yes / DO NOT FLY / Cadet strapped sitting upright; no first aid available in flight. Risk of confusion/ impaired behaviour post-recovery.
Recent surgery or anaesthetic (any) / No / Yes / DO NOT FLY UNTIL FULLY RECOVERED - MINIMUM 7 DAYS / Risk from trapped gas, limited mobility, wound opening, pain.
Pneumothorax / No / Yes / DO NOT FLY FOR 1 MONTH FROM LAST TREATMENT / Risk from trapped gas
Acute, unstable or untreated psychiatric conditions, including fear of flying & claustrophobia / No / Yes / DO NOT FLY UNTIL TREATED AND SYMPTOMS STABLE / Behaviour in-flight: risk to person and aircraft
Any stable chronic disease not covered above / No / Yes / START F6424 PROCEDURE - RISK ASSESS GP / CFMO / Stable disease may be acceptable for short pax flight if activities of daily living are not unduly impaired
Any disease with sudden or unpredictable onset or deterioration / No / Yes / START F6424 PROCEDURE - RISK ASSESS GP / CFMO / The risk of sudden incapacitation (spontaneous or precipitated by flight environment) should be risk assessed against proposed flight profile.
Asthma STEP 15 / No / Yes / FIT TO FLY IF CONDITIONS STABLE - MUST CARRY MEDICATION IN FLIGHT / Acceptable for passenger flight if medication available and disease stable (occasional inhaler use; no rescue medication (eg steroids, antibiotics) in last month)
Asthma STEP 2 or higher5 / No / Yes / START F6424 PROCEDURE - RISK ASSESS GP / CFMO / More severe disease may be acceptable for ghosted solo standard, iaw AP1269A Lflt .
Diabetes Type 1: Acceptable if well controlled. / No / Yes / FIT TO FLY IF CONDITIONS STABLE - MUST CARRY GLUCOSE IN FLIGHT / Type 1 acceptable if blood sugars are well controlled. Insulin pump (if used) should be integrated with AEA. Check sugars prior to flight.
Diabetes Type 2 / No / Yes / FIT TO FLY / Acceptable.
Haematological (blood) disorders / No / Yes / START F6424 PROCEDURE - RISK ASSESS GP / CFMO / Any disorder of coagulation (whether constitutional or acquired) should be carefully risk assessed. Severe anaemia (<9) is unfit until treated.
Migraines / No / Yes / RISK ASSESS. DO NOT FLY WITH SYMPTOMS OR ATTACK CAN OCCUR WITHIN FLIGHT TIMEFRAME / Do not fly with symptoms. Do not fly if typical attack can occur within the timeframe of flight. Visual or neurological symptoms of particular concern.
Cognitive, emotional, behavioural or developmental conditions (including ADHD, conduct disorders, dyspraxia and autism spectrum disorders) / No / Yes / START F6424 PROCEDURE - RISK ASSESS GP / CFMO / Cadets are to understand and follow clear instruction. Any condition, whether treated or not, should not be so severe as to impair understanding of emergency drills or lead to behaviour that would endanger the aircraft.
Stable injury, illness or condition limiting mobility or use of limbs / No / Yes / START F6424 PROCEDURE - RISK ASSESS GP / CFMO / Consider cockpit assessment and integration check with AEA. Special consideration of effect on emergency egress.
Stable psychiatric disorders / No / Yes / START F6424 PROCEDURE - RISK ASSESS GP / CFMO / Assess likely behaviour in-flight: consider risk to person and aircraft
Severe allergy (including epipen or equivalent) / No / Yes / FIT TO FLY IF CONDITIONS ACCEPTABLE - SEE COMMENTS. MUST CARRY MEDICATION IN FLIGHT / If generally stable, with a clearly identified allergen that is avoidable then fit to fly. Very severe, unstable or unpredictable reactions are unfit. Those likely to be exposed to allergen (eg plastics, rubbers) in flight are unfit.
Further Information
Cadet Name:
Sqn / Wing:
Signature of Cadet / Date
Declaration: I hereby declare that I have carefully considered the statements made above and that to the best of my belief they are complete and correct and that I have not withheld any relevant information or made any misleading statements. I also confirm that should the cadets medical history change since the medical examination above, I will ensure that the relevant ATC Sqn OC / CCF (RAF) Section Cdr is informed and a new ACO Av Med Form 1 is produced.
Parent/Guardian Signature
(Paper) VER 1.01
PERIOD OF VALIDITY: VALID FOR THREE MONTHS FROM DATE OF DECLARATION
:
GUIDANCE NOTES FOR COMPLETION ACO Av Med Form 1
1. Certain medical and physical conditions are incompatible with flying as they could place the cadet at risk and compromise Air Safety. A list of medical conditions incompatible with gliding/flying training or which may require further medical scrutiny can be found in ACO Av Med Form 1 - Conditions Requiring Medical Assessment for VGS Gliding/AEF Flying.
2. The ACO Av Med Form 1 should be completed by ticking either Yes or No to the question asked. The disposal field advises of the actions which may be required to gain medical clearance if any responses are Yes .
3. The applicant should complete, in full, all questions (sections) on the form. Failure to complete the form in full will result in non-acceptance of the form.
4. The ACO Av Med Form 1 must be signed by you and your parent/guardian (if under 18 years of age) to validate the certificate.
6. To satisfy gliding/flying medical requirements, cadets must be in possession of a completed ACO Av Med Form 1. Failure to be in the possession of a completed and signed Av Med Form 1 will invalidate the eligibility of a cadet to undertake gliding training. VGS/AEF staff are directed to refuse flying training to cadets not in possession of the relevant signed forms at the point of delivery.
7. Period of validity: Although this declaration is valid for three months from the date of signing, it is immediately invalidated should any change in fitness or health occur.
8. Reduction in Medical Fitness: If referred for a medical investigation or procedure, or after any serious illness or injury, you must reassess your medical fitness to fly. It is your responsibility to ensure that a new ACO Av Med Form 1 completed before undertaking aviation activity.
9. Corrective lenses If you wear spectacles or contact lenses a readily available spare pair of spectacles must be carried when flying.
10. After Signing: Cadets are to hand the ACO Av Med Form 1 to your ATC Sqn OC / CCF (RAF) Section Cdr for scrutiny.
:
:
:
: