Section 26

Aviation*

If uncertain whether a condition might affect flight safety, then the physician should discuss the case with a RAMO. See Section 26.7, Contacts, for information about reaching a RAMO.

If certain that a condition might affect flight safety, the physician must take the following steps:

• Advise the pilot of the medical condition.
• Remind the pilot of their obligations under CARs Section 404.06 to not exercise the privileges of their licence or permit; i.e., to self-ground.
• Report the case to a RAMO. The report will be confidential and privileged.
  • Reports can be made by telephone or in writing using the Civil Aviation Medicine Medical Condition Reporting Form (26-0011). This report can be submitted electronically and is confidential and privileged. See section entitled “Reporting a Medical Condition” at https://tc.canada.ca/en/aviation/medical-fitness-aviation/assessing-medical-fitness-pilots-air-traffic-controllers#toc6.
• Once a report under Section 6.5 of the Aeronautics Act has been made, it is the RAMO’s responsibility to take further action. Although Transport Canada may use the reported information as necessary to ensure aviation safety, the report itself cannot be used as evidence in any legal, disciplinary, or other proceedings against the reporting physician.

Physicians may wish to contact the Canadian Medical Protective Association for advice should they have questions about their reporting obligation. See also Section 3, Reporting — when and why, in this guide.

Some lower-risk categories of aviation licences and permits do not require applicants for a medical certificate to visit a CAME. A pilot can instead visit any licensed physician in Canada to request that the physician countersign a medical declaration form, indicating they are fit to perform the aviation duties associated with the particular category of licence or permit. If the pilot does not have any of the conditions listed on the declaration, then the physician may countersign the declaration. However, if in the physician’s opinion the applicant may require further assessment for fitness for aviation, the physician may recommend that the applicant seek a medical examination from a CAME.

Conditions where visual impairment is temporary or vision is temporarily affected by the use of medications need not be reported. Pilots should be advised not to fly until normal vision has returned.

Reporting of the following is mandatory:

• diplopia
• monocular vision
• visual field defects — including partial loss of a visual field or significant scotoma
• eye injuries or retinal detachment
• cataract surgery
• surgical correction of myopia following radial keratotomy, photorefractive keratectomy, laser- assisted in situ keratomileusis, or other refractive eye surgery.

Significant deterioration in hearing must be reported. In addition, a normally functioning vestibular system is of the utmost importance, so any condition affecting balance or spatial orientation must be reported.

Reporting of the following is mandatory:

• hearing loss — sudden loss of hearing or conditions significantly affecting hearing
• middle-ear conditions — damage to the tympanic membranes or the eustachian tubes
• inner-ear conditions — any condition affecting or impinging on the inner ear or the vestibular (balance) organs
• stapedectomy and other ear surgery
• surgery affecting the nasal passages, sinuses, or eustachian tubes
• conditions leading to voice distortion or inaudibility.

Cardiovascular illness is a significant concern for aviation safety, and a RAMO must be notified. Reporting of the following is mandatory:

• cardiac inflammation and infection
• acute ischemic syndromes
• angina pectoris — chest pain typical or atypical of angina pectoris
• myocardial infarction
• revascularization surgery or angioplasty (including stent insertion)
• cardiomyopathy
• cardiac transplantation.

Pilots who show any evidence of memory loss, poor concentration, or diminished alertness must be reported.

Reporting of the following is mandatory:

• transient ischemic attacks or cerebral artery stenosis that has led to confusion, disturbance of vision, attacks of vertigo, or loss of consciousness
• stroke — completed stroke or any other cerebrovascular accident
• carotid endarterectomy
• carotid bruits.

Reporting of the following is mandatory:

• aortic aneurysms
• symptomatic or enlarging thoracic aneurysm or abdominal aneurysm 5 cm in diameter or larger
• recent surgical repair of an aneurysm
• deep venous thrombosis.

Disorders of the central nervous system can result in subtle or sudden incapacitation, which can be fatal in the aviation environment.

Reporting of the following is mandatory:

• syncope or pre-syncope
• seizure disorders
• head injuries — any significant head injury, particularly if it is associated with unconsciousness or post-traumatic amnesia
• sleep disorders of any type
• vestibular disorders — spatial disorientation is a significant cause of aviation incidents/crashes; any condition that interferes with balance or coordination
• headache — migraine with aura; may include visual loss, cognitive impairment, and other neurologic deficits; any type of severe or prolonged headache requiring medications
• disorders of coordination and muscular control.

Gradual deterioration of the respiratory system over years may not be obvious, particularly if the pilot does not complain or is using bronchodilator medications.

Reporting of the following is mandatory:

• chronic obstructive pulmonary disease — significant decreases in pulmonary function, decreased arterial oxygen saturation, increasing hypercapnia, or recurrent infections
• asthma — on initial diagnosis or if there is an increasing requirement for inhaled bronchodilators, steroids, or other medications
• pneumothorax — spontaneous pneumothorax, pleural blebs, lung cysts, or other conditions that may lead to problems with expansion of trapped gas
• pulmonary embolism
• sarcoidosis.

Reporting of the following is mandatory:

• diabetes mellitus
• type 1 diabetes — on initial diagnosis; pilots and air traffic controllers with type 1 diabetes are considered for certification by a RAMO, on an individual basis
• type 2 diabetes — treatment with oral or injected hypoglycemic drugs and/or insulin therapy; changes in type or dose of medication; hypoglycemic attacks requiring treatment
• thyroid and parathyroid disease — on initial diagnosis of these conditions and when there are significant changes in treatment
• pituitary disease — on initial diagnosis and investigation; any mass compromising the optic chiasm
• adrenal disease — on initial diagnosis and investigation
• use of anabolic steroids.

Reporting of the following is mandatory:

• renal colic or the discovery of kidney or bladder stones
• development of renal failure or treatment with renal dialysis
• requirement for renal transplantation; after successful transplantation, when there are significant changes in treatment.

Reporting of the following is mandatory:

• recent amputation of a limb or part of a limb
• arthritis — symptomatic patients whose mobility becomes restricted; those with adverse effects from medications (e.g., non-steroidal anti-inflammatory drugs); those requiring second- or third- stage medications (e.g., gold, azathioprine)
• any condition that could impair functionality in the aviation environment, such as distracting pain, reduced strength, or reduced range of motion.

Psychiatric or mental illness is concerning for aviation safety. Even when symptoms are effectively treated, the adverse effects of medications used for treatment, such as selective serotonin reuptake inhibitors (SSRIs), may not be compatible with aviation.

Pilots with mental health issues may be reluctant to discuss their conditions with a CAME and may be more likely to seek advice and treatment from a family or community physician. Pilots are generally not permitted to exercise the privileges of their licences or permits until their cases have been assessed by a RAMO.

Reporting of the following is mandatory:

• cognitive disorders — including dementia, as soon as suspected or diagnosed
• psychosis — including bipolar affective disorder
• mood disorders — including anxiety and depression
• substance use disorders — including episodes of substance use that could be concerning for aviation safety (e.g., impaired driving conviction or substance use while performing aviation duties); see also Section 26.6, Substance use
• attention-deficit/hyperactivity disorder — either with or without medication for management.

Reporting of the following is mandatory:

• any diagnosis of significant illness that may affect aviation safety, due to either the effects of the underlying illness or the effects of treatment.