**Executive Summary**
This Civil Aviation Requirement (CAR) issued by the Office of Director General of Civil Aviation, effective immediately from May 5th, 2014, outlines the medical requirements and examinations for cabin crew. This CAR aims to ensure uniform standards of medical fitness. Operators must implement and document a system for initial and periodic medical examinations based on these guidelines.
**Key Points / Main Content**
* **Applicability and Supersession:**
* This CAR is issued under Rule 38B and Rule 133A of the Aircraft Act, 1937.
* It modifies Para 4.1.2 of Civil Aviation Requirement Section 7, Series M, Part I issued on 15 Mar 2010.
* It cancels Cabin Safety Circular 3 of 2012 dated 24 July 2012.
* **Medical Examination Requirements:**
* All cabin crew must undergo initial and renewal medical examinations equivalent to Class 2 Medical Examination.
* Examinations must assess physical, mental, visual/color perception, and hearing abilities.
* Cabin crew must be free from any condition that could impair their duties.
* **Frequency of Medical Examinations:**
* Initial exam upon induction.
* Renewal every four years until age 40, every two years until age 50, and yearly thereafter.
* Frequency may increase based on specific conditions.
* **Required Investigations/Records:**
* **Initial Medical Examination:** Height, weight, BMI, blood pressure, complete ophthalmic and ENT exams, audiogram, haemogram, urine routine, blood group, ECG, chest radiograph, blood sugar, lipid profile, thyroid and liver function tests, kidney function test, and abdomen/pelvis ultrasound.
* **Renewal Medical Examination:** Haemogram, urine routine, height, weight, BMI, blood pressure, complete ophthalmic and ENT exams, ECG (if indicated), audiogram (if indicated), blood sugar, HbA1c, lipid profile, thyroid and liver function tests, kidney function test, and abdomen/pelvis ultrasound. *ECG & Audiogram are to be done only if clinically indicated in renewal medical examinations till the age of 50. After 50, it is to be done once every 2 years.*
* **Approved Medical Examiners:**
* DGCA authorized Class 1 and Class 2 Medical Examiners.
* Airline Medical Department doctors with aerospace medicine training.
* DMS (CA) may authorize special medicals in contentious cases.
* **Rostering and Functional Assessment:**
* Cabin crew must have a valid medical examination report to be rostered.
* Qualified Cabin Crew Instructors will conduct functional assessments of overweight/obese cabin crew to determine fitness for duty.
* **Record Maintenance:**
* Airlines must maintain individual medical records and yearly summaries.
* **Disposal of Medical Cases:**
* Medical reports will be handed to the cabin crew at the end of the medical examination, with the disposal being fit, temporary unfit, or permanent unfit.
* Permanent unfit cases may be referred to the Medical Assessor at DGCA.
* **Appeal Process:**
* Cabin crew declared unfit may appeal to the Medical Assessor at DGCA within 90 days.
* Specific documents are required for the appeal.
**Impact Analysis**
**Impact**:
* Must ensure cabin crew meets medical requirements.
* Must maintain records and schedules for medical examinations.
* Must adhere to disposal guidelines for medical cases.
* Must ensure a functional assessment for fitness for duty
**Action Required**:
* Implement and document the system for cabin crew initial and periodic medical examination.
* Forward annual summary of medical examinations to DGCA.
**Impact**: Cabin Crew
* Must undergo required medical examinations and meet the fitness standards.
* Have the right to appeal medical assessment if declared unfit.
**Action Required**:
* Prepare for and attend medical examinations as required.
* File appeals within 90 days if declared unfit.
**Impact**: Medical Examiners/Centers
* Must follow specified procedures and guidelines for conducting medical examinations.
* Must determine medical fitness based on established standards.
**Action Required**:
* Comply with the CAR requirements for medical examinations.
* Provide reports and documentation as required.
Key Entities Referenced
Aircraft Rules, 1937: Regulates aviation in India, with Rule 38B specifically addressing cabin crew.
Civil Aviation Requirements (CAR): A set of regulations issued by the DGCA, this specific CAR addresses medical requirements for cabin crew.
Directorate General of Civil Aviation (DGCA): The Indian governmental regulatory body for civil aviation, responsible for issuing and enforcing aviation regulations.
Class 2 Medical Examination: A specific type of medical examination required for certain aviation personnel, as referenced in the document.
Aircraft Act, 1937: This CAR is issued under the provisions of Rule 38B and Rule 133A of the Aircraft Act, 1937.
GOVERNMENT OF INDIA
OFFICE OF DIRECTOR GENERAL OF CIVIL AVIATION
TECHNICAL CENTRE, OPP SAFDARJANG AIRPORT, NEW DELHI
CIVIL AVIATION REQUIREMENTS
SECTION 7 – FLIGHT CREW STANDARDS
TRAINING AND LICENSING
SERIES C PART II
ISSUE I, 5TH MAY 2014
EFFECTIVE: FORTHWITH
F. No. AV/22025/28/DMS/MED
SUBJECT: MEDICAL REQUIREMENTS AND EXAMINATION FOR CABIN
CREW
1. INTRODUCTION
The Rule 38B of the Aircraft Rules, 1937 deals with carriage of cabin
crew. The sub-clause (d) of clause (3) of this rule provides that the
operator shall ensure that each cabin crew member remains medically
fit to discharge the duties specified in the Operations Manual. For this
purpose this CAR is issued to lay down uniform requirements of medical
fitness of cabin crew to be ensured by the operators. This CAR is issued
under the provisions of Rule 38B and Rule 133A of the Aircraft Act, 1937.
With the issue of this CAR, (a) the provisions of Para 4.1.2 of Civil
Aviation Requirement (CAR) Section 7, Series M, Part I issued on 15
Mar 2010 would stands modified and (b) the Cabin Safety Circular 3 of
2012 dated 24 July 2012 stands cancelled.
2. REQUIREMENTS FOR MEDICAL EXAMINATION
2.1 All cabin crew shall undergo initial and renewal medical examination of
equivalent to Class 2 Medical Examination.
1CIVIL AVIATION REQUIREMENTS SECTION 7
SERIES C PART II 5TH MAY 2014
2.2 All cabin crew shall undergo a medical examination based on the
following requirements:
(a) Physical and mental;
(b) Visual and colour perception; and
(c) Hearing.
2.3 Cabin crew shall be free from:
(a) Any abnormality, congenital or acquired; or
(b) Any active, latent, acute or chronic disability; or
(c) Any wound, injury or sequelae from operation; or
(d) Any effect or side-effect of any prescribed or non-prescribed therapeutic,
diagnostic or preventive medication (including herbal/ alternative medicine
modalities) taken;
such as would entail a degree of functional incapacity which is likely to I
nterfere with the safe performance of their duties.
2.4 The medical examination shall take into account the medical history,
general and systemic clinical examination findings.
2.5. Frequency of Medical Examination. The Initial Medical Examination shall be
conducted upon induction. Subsequently, cabin crew shall undergo renewal
medical examination once every four years till the age of 40 yrs, once every
two years till the age of 50 yrs and yearly thereafter. The frequency of
medical examination may be increased in case of specific cabin crew where
a disease/condition has been detected and a more frequent follow up is
desirable.
2.6 All cabin crew shall undergo the following investigations/ records using
Form CA-34 & 35:
Record of height, weight & Body Mass Index
Initial Medical • (BMI)
Examination • Blood Pressure
• Complete Ophthalmic Examination (visual fields,
distance and near visual acuity with and without
correction, colour vision on Ishihara/Tokyo
Medical
College (TMC) chart, ocular muscle balance)
• Complete Ear Nose & Throat (ENT) Examination
including Pure Tone Audiogram
• Haemogram (Complete Blood Counts)
2CIVIL AVIATION REQUIREMENTS SECTION 7
SERIES C PART II 5TH MAY 2014
• Urine routine & microscopic examination
• Blood Group & Rh Type
• Electrocardiogram (ECG) - standard 12 lead with
long lead II
• Radiograph Chest PA view
• Blood Sugar Fasting
• Lipid Profile
• Thyroid Function Test (T3, T4 & TSH)
• Liver Function Test
• Kidney Function Test
• Ultrasonography Abdomen & Pelvis
• Any other test deemed fit based on history/ clinical
examination
Haemogram (Complete Blood
Renewal Medical • Counts)
Urine routine & microscopic
Examination • examination
• Record of height, weight, BMI
• Blood Pressure
• Complete Ophthalmic Examination (visual fields,
distance and near visual acuity with and without
correction, colour vision on Ishihara/ TMC chart,
ocular muscle balance)
• Complete ENT Examination
• ECG*
• Pure Tone Audiogram*
• Blood Sugar Fasting
• HbA1c
• Lipid Profile
• Thyroid Function Test (T3, T4 & TSH)
• Ultrasonography Abdomen & Pelvis
• Any other test deemed fit based on history/clinical
examination
* ECG & Audiogram are to be done only if clinically
indicated in renewal medical examinations till the age
of 50. After 50, it is to be done once every 2 years
(that is during the medical that is due after completing
the age of 50, 52, and so on)
Note: Standards for overweight/ obese for Cabin Crew shall be dealt in conformity
with AIC 09/2008 titled ‘Obesity & Commercial Aircrew’.
3CIVIL AVIATION REQUIREMENTS SECTION 7
SERIES C PART II 5TH MAY 2014
2.7 The provisions as applicable for Class 2 Medical Examinations as
brought out in ICAO Annex 1 Chapter 6 para 6.2.3, 6.2.4, 6.2.5, 6.4.1,
6.4.2, 6.4.3, 6.4.4 and 6.4.5 read in conjunction with ICAO document
8984 ‘Manual of Civil Aviation Medicine’ as amended from time to time
shall be followed. In addition, the provisions available in AICs 28/199,
3/2007, 4/2007, 9/2008, 10/2008 & 13/2008 as amended shall also serve
as guidelines.
2.8 No cabin crew shall be accepted for rostering unless they have a valid
medical examination report.
2.9 Functional Assessment of overweight/ obese Cabin Crew shall be
carried out by the ‘ Qualified Cabin Crew Instructor’ at the time of making
decision about fitness for duty to assess whether she/he is able to carry
out various activities towards handling of aircraft emergencies and
medical emergencies as effectively as is expected.
3. APPROVED MEDICAL EXAMINERS/MEDICAL EXAMINATION
CENTRES
3.1 The following authorities can carry out Class 2 Medical Examinations:
(a) All DGCA authorised Class 1 Medical Examiners.
(b) All DGCA authorised Class 2 Examiners.
(c) Doctors or Airline Medical Department who have undergone a minimum one
week training in Aerospace Medicine at the Institute of Aerospace Medicine,
Bangalore.
(d) In contentious cases, DMS (CA) may authorise a review/ special medical at
IAM Bangalore/AFCME New Delhi/ MEC(East) Jorhat or any other IAF
centre.
The list of centres & examiners listed in para 3.1 (a) & (b) is available on
DGCA website (as amended from time to time). The choice of centre/
examiner shall be of the Airline Medical Department/ Operator.
3.2 The induction of Medical Examiners, their training requirements and
recurrent training is as per the CAR Section 7 Series ‘C’ Part I.
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SERIES C PART II 5TH MAY 2014
4. PROCEDURE AND GENERAL REQUIREMENTS FOR MEDICAL
EXAMINATION
4.1 Maintenance of Medical Records. The concerned department of
scheduled airlines and the Operator of non-scheduled airlines shall
maintain the individual medical records of all their cabin crew. A yearly
summary of the total number of induction and renewal medical
examinations conducted and their outcome may be forwarded to DGCA
for scrutiny and retention.
4.2 Maintenance of schedule for Medical Examination. The concerned
department of scheduled airlines and the Operator of non-scheduled
airlines shall be responsible for maintaining a schedule to ensure timely
conduct of medical examinations of all their cabin crew.
4.3 Disposal of Cases. Cabin crew shall be handed over a medical report at
the end of the medical examination. The following disposals may be
granted:
(a) Fit
(b) Temporary Unfit
(c) Permanent Unfit
4.4 Disposal of Temporary Unfit Cases. Cases may be declared Temporary
Unfit for a specified duration for a disease/ condition with specific
annotation regarding the next review and guidance on the investigations/
opinion/ treatment required before next review.
.5 Disposal of Permanent Unfit Cases. Cases requiring to be placed
‘Permanently Unfit’ may be referred to Medical Assessor at DGCA with
full justification and supporting medical documents.
4.6 Disposal of contentious cases & arbitration. The first level of dealing with
such cases would be the Airline Medical Department itself. In cases
where the matter is not resolved, the same may be referred to Medical
Assessor at DGCA. The Medical Assessor may advise for investigations/
opinions/ fresh medicals at IAF centres before finalising the case.
5CIVIL AVIATION REQUIREMENTS SECTION 7
SERIES C PART II 5TH MAY 2014
4.7 If the medical standards prescribed for Class 2 Medical Examination and
those laid down by DGCA are not met, the Medical Fitness shall not be
issued or renewed unless the following conditions are fulfilled:
(a) Accredited medical conclusion indicates that in special circumstances
the applicant’s failure to meet any requirement, whether numerical or
otherwise, is such that exercise of the duties is not likely to jeopardize
flight safety;
(b) Relevant ability, skill and experience of the applicant and operational
conditions have been given due consideration; and
(c) The medical fitness is endorsed with any special limitation or limitations
when the safe performance of the cabin crew duties is dependent on
compliance with such limitation or limitations.
5 PROCEDURE FOR APPEAL MEDICAL EXAMINATION
5.1 In the event of a cabin crew being declared temporarily medically unfit
for more than six months at a stretch or in aggregate or permanently
unfit, the applicant may appeal to the Medical Assessor at DGCA for a
review of the medical assessment within a period of 90 days from the
date of applicant having been declared unfit.
5.2 The appeal shall be addressed to Director, Medical Services (Civil
Aviation), Director General of Civil Aviation, Technical Centre, Opposite
Safdarjung Airport, New Delhi-110003. The appeal shall be sent by
registered post with acknowledgement due or by Speed Post or through
a reputed courier company or may be delivered in person to the Receipt
& Despatch Section in the O/o DGCA and obtain a receipt for the same.
The appeal must be accompanied by the following documents:
(a) All documents in original obtained by the applicant from reputed medical
institutions/ specialists clearly certifying that the applicant is fit for duties
as cabin crew, with specific reference to the cause of unfitness stated in
the medical assessment issued by the office of DGCA. The medical
practitioner/ specialist certifying the fitness in such a case should give
sound reasons justifying their opinion.
(b) Reports of the medical examination and results of investigations, in
original, conducted by the medical practitioner/ specialist giving the
aforesaid certificate.
6CIVIL AVIATION REQUIREMENTS SECTION 7
SERIES C PART II 5TH MAY 2014
5.3 The appeal shall be considered by DGCA, and if found justified, it may
be referred to DGMS (Air). Medical records of the concerned cabin crew
shall be summoned by DGCA. If adequate medical evidence is provided
for medical review, DGMS (Air) may recommend to DGCA an appeal/
review medical examination at any place and may also ask for any such
investigation/ report or opinion of any specialist to determine the fitness
of the applicant. In case the appeal for medical review is not found
justified, DGMS (Air) will inform DGCA about the same giving the
reasons and the cabin crew shall b e informed accordingly.
5.4 If the medical review is accepted, it shall be carried out at the centre
specified for the purpose. The fresh medical examination reports will be
considered to assess the medical fitness. The decision of the DGMS
(Air) on behalf of DGCA shall be final. The result thereof s hall be
intimated by the Medical Board to the O/o DGCA and the final asses
sment shall be issued accordingly by DGCA.
6. M AINTENANCE OF RECORDS
The records of the medical examination of c abin crew shall be
maintained by the concerned department of scheduled airline/
operators. These would be examined during the DGCA inspections.
7. CONCLUSION
All operators are to ensure that a system for cabin crew initial (induction/
employment) and periodic medical examination based on guidelines
above is instituted, documented and implemented.
(B. S. Bhullar)
Director General of Civil Aviation
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