AEF Med Form.xls

	B	C	D	E	F
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3					ACO Av Med Form 1
4		PROTECT - PERSONAL (WHEN COMPLETE)
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6		CONDITIONS REQUIRING MEDICAL ASSESSMENT FOR VGS GLIDING/AEF FLYING
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8		TO COMPLETE SELECT Y/N FROM DROP DOWN LIST
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10		CONDITION OR EVENT	Y/N	DISPOSAL	COMMENTS - FURTHER GUIDANCE
11		Recent immunisations or blood donation	No	FIT TO FLY	Compatible with RA21351
12		Acute illness (or flare of chronic condition) or new treatment	No	FIT TO FLY	Compatible with RA21351
13		Acute injury limiting mobility or use of limbs	No	FIT TO FLY	Unnecessary risk, limiting emergency drills.
14		ENT or sinus conditions	No	FIT TO FLY	Cadets are to be able to safely tolerate barometric changes.
15		Pregnancy	No	FIT TO 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 13
16		Any condition that requires oxygen therapy	No	FIT TO FLY	Adverse effect of altitude. Integration of medical eqpt into cockpit. CAA Guidelines4
17		Unstable or brittle medical condition	No	FIT TO FLY	Unreasonable to fly anyone with a predictable risk of incapacitation within the timescale of flight (or symptoms brought on by stressors of flight)
18		Limited excercise capacity/tolerance due to chest (heart or lung) illness or disease	No	FIT TO 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)
19		Fits, faints, blackouts (including epilepsy)	No	FIT TO FLY	Cadet strapped sitting upright; no first aid available in flight. Risk of confusion/ impaired behaviour post-recovery.
20		Recent surgery or anaesthetic (any)	No	FIT TO FLY	Risk from trapped gas, limited mobility, wound opening, pain.
21		Pneumothorax	No	FIT TO FLY	Risk from trapped gas
22		Acute, unstable or untreated psychiatric conditions, including fear of flying & claustrophobia	No	FIT TO FLY	Behaviour in-flight: risk to person and aircraft
23		Any stable chronic disease not covered above	No	FIT TO FLY	Stable disease may be acceptable for short pax flight if activities of daily living are not unduly impaired
24		Any disease with sudden or unpredicatble onset or deterioration	No	FIT TO FLY	The risk of sudden incapacitation (spontaneous or precipitated by flight environment) should be risk assessed against proposed flight profile.
25		Asthma STEP 15	No	FIT TO FLY	Acceptable for passenger flight if medication available and disease stable (occasional inhaler use; no rescue medication (eg steroids, antibiotics) in last month)
26		Asthma STEP 2 or higher5	No	FIT TO FLY	More severe disease may be acceptable for ghosted solo standard, iaw AP1269A Lflt .
27		Diabetes Type 1: Acceptable if well controlled.	No	FIT TO FLY	Type 1 acceptable if blood sugars are well controlled. Insulin pump (if used) should be integrated with AEA. Check sugars prior to flight.
28		Diabetes Type 2	No	FIT TO FLY	Acceptable.
29		Haematological (blood) disorders	No	FIT TO FLY	Any disorder of coagulation (whether constitutional or acquired) should be carefully risk assessed. Severe anaemia (<9) is unfit until treated.
30		Migraines	No	FIT TO FLY	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.
31		Cognitive, emotional, behavioural or developmental conditions (including ADHD, conduct disorders, dyspraxia and autism spectrum disorders)	No	FIT TO FLY	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 behavior that would endanger the aircraft
32		Stable injury, illness or condition limiting mobility or use of limbs	No	FIT TO FLY	Consider cockpit assessment and integration check with AEA. Special consideration of effect on emergency egress.
33		Stable psychiatric disorders	No	FIT TO FLY	Assess likely behaviour in-flight: consider risk to person and aircraft
34		Severe allergy (including epipen or equivalent)	No	FIT TO FLY	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.
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36	1	RA2135
37	2	AP1269A Lflt 5-16
38	3	JSP 950 6-7-5 Annex J Appendix 1
39	4	Civil Aviation Authority - Cardiovascular Disease Guidelines
40	5	British Guidline on the Management of Asthma - Quick Reference Guide
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42		Cadet Name:
43		Cadet Name:
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45		Date:
46		Date:
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48		Signature of Cadet:
49		Signature of Cadet:
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51		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 statement.
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53		Parent/Guardian Signature:
54		Parent/Guardian Signature:
55					VER 1.00
56		PERIOD OF VALIDITY: VALID FOR ONE MONTH FROM DATE OF SIGNATURE
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60		GUIDANCE NOTES FOR CCOMPLETION ACO Av Med Form 1
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62		1. Certain medical and physical conditions are incompatible with gliding 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.
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64		2. The ACO Av Med Form 1 should be completed fully by using the Y/N drop down list which indicates the suitablity for gliding/flying training. The disposal field advises of additional actions which may be required to gain medical clearance.
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66		3. The ACO Av Med Form 1 must be signed by you and your parent/guardian (if under 16 years of age) to validate the certificate.
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68		4. 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. The making of false or misleading statements or withholding of relevant information will result in denial of this medical clearnace and (exceptionally) the withdrawal of any future medical clearance.
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70		5. 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 countersigned Av Med Form 1 will invalidate the eligibility of a cadet to undertake gliding training. VGS staff are directed to refuse gliding training to cadets not in possession of the relevant signed forms at the point of delivery.
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72		6. Period of validity: The declaration will expire after a period of one month from the date of signing unless some other illness occurs in the meantime.
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74		7. Reduction in Medical Fitness: If referred for a medical investigation or procedure, or after any serious illness or injury, you must reasses your medical fitness to fly. It is your responsibility to ensure that a new ACO Av Med Form 1 completed before undertaking aviation activity.
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76		8. Corrective lenses If you wear spectacles or contact lenses a readily available spare pair of spectacles must be carried when flying.
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78		9. After Signing: Cadets are to hand the ACO Av Med Form 1 to your ATC Sqn OC / CCF (RAF) Section Cdr for scrutiny.
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