Aviation Medicine | What Pilots Aren't Taught in Flight School
- Dr. Rob Massera | DAME
- Jul 15
- 4 min read
Whether you're flying left seat or logging hours as a student, aviation medicine helps to keep pilots fit-to-fly & the skies safe for crew, passengers, and the wider public. But what exactly is it? Why is it any different from other branches of medicine and how does it impact your ability to fly?
Q: What is Aviation Medicine?
Aviation medicine, or aerospace medicine, is a specialized field of practice at the intersection between human physiology, human performance and flight safety in the aviation environment.
It is concerned with: (a) the interaction between pilot physiology & cognitive performance in the flight-environment and (b) certification of pilots as medically fit to safely operate aircraft. Designated Aviation Medical Examiners (DAMEs) are trained to assess a pilot’s health & monitor existing medical conditions, as well as treatments, that could impair or incapacitate a pilot.
Q: Why is Aviation Medicine Practiced?
Flying places unique demands on the body & mind - such as: low pressures, low oxygen & low temperatures, G-forces, trans-meridian travel, long duty periods and high cognitive loads. Meaning that even seemingly minor medical issues can potentially impair pilot performance in flight. Aviation medicine exists to minimize the risk that a pilot becomes impaired or incapacitated while flying. Ultimately, it’s about managing medical risk & supporting pilot wellbeing while keeping aviation safe.
For example: a pilot who suffers from hay-fever & takes an antihistamine that causes sedation, unwittingly impairs their situational awareness & increases risk of an incident or accident.
Q: How Are Pilots Medically Certified?
The Civil Aviation Safety Authority (CASA) provides medical certification based on license type. A private pilot licence holder requires a class 2 medical certificate, while a Class 1 medical certificate is mandatory for commercial pilots. To obtain a class 1 medical certificate, a pilot must undergo a comprehensive initial and annual medical assessment by a CASA Designated Aviation Medical Examiner (DAME) including: thorough medical review, head-to-toe physical examination, vision assessment (initially with a CASA accredited ophthalmologist or optometrist), audiometry, ECG, blood tests & urinalysis. In contrast, a class 2 medical certificate only requires additional tests if indicated.
If there are no disqualifying conditions & the pilot meets the medical standard class 1 set out in CASR Part 67.150, or the medical standard class 2 set out in CASR Part 67.155 certification is generally issued within 2 to 4 weeks.
However, if the pilot does NOT meet the medical standard & aero-medically significant issues are identified, CASA’s AvMed team will review the case and may request more information from specialist reports or tests. The objective is to determine whether the condition, its treatment, and the flight-environment interact to increase the risk of impairment or incapacitation above the 1% threshold & if so whether the risk can be safely mitigated.
Q: What is the 1% Rule & How Is Incapacitation Risk Assessed?
Pilots often hear of the “1% rule” without fully understanding it. This rule is a benchmark used by aviation medical authorities worldwide to assess whether a medical condition is acceptable for certification. Specifically, it states that the risk of total incapacitation for single pilot commercial operations must not exceed 1% per year (while 2% per year is applied to single-pilot private operations). This means that over a 12-month period, a pilot’s risk of experiencing a disabling event - like a stroke or heart attack - must be less than 1 in 100 per year to qualify for a class 1 medical certificate.
Q: How Is the 1% Rule Derived?
The 1% rule comes from probabilistic risk modelling developed in the 1970s by the UK's Civil Aviation Authority. The model estimates the likelihood of pilot incapacitation during flight, factoring in: aircraft hours flown, flight phases and system redundancies, like dual-pilot crews. The goal is to ensure that the total risk of a fatal accident due to medical incapacitation remains below thresholds deemed acceptable in aviation - 1 in 10^9 flight hours. This means that there should be no more than 1 fatal accident due to medical incapacitation per billion hours flown.
By applying the 1% principle, aviation medicine aims to balance public safety with pilot fairness, ensuring pilots with stable conditions can continue flying.
Q: What can pilots do to maintain their medical certification over their flying career?
In short observe a maintenance schedule for your "biocraft" to keep your Body in BioTRIM. Just as an aircraft’s instruments indicate when it is in or out of trim, your biometrics tell whether your "biocraft" is in trim:
T = Thoughts & Mental State - awareness of thoughts + stress levels
R = Rest, Recreation & Relationships - 8 to 9 hours sleep + taking time for R&R
I = Intake & Nutrition - high quality nutrition + hydration
M = Movement & Maintenance cycle - Regular resistance training + a tailored maintenance cycle with your GP, DAME & Dentist
Biometrics = BMI, Blood Pressure, Heart Rate, Urinalysis, BSL & Blood lipid studies
By consistently applying the BioTRIM framework your biometrics are likely to remain within the ideal configuration - helping you stay fit-to-fly and well below the 1% incapacitation threshold.
The Bottom line - Aviation medicine isn’t just red tape - it helps keep you fit-to-fly, as well as your crew, passengers & the public safe.
Q: Got more questions?
Contact us: info@aerokare.com.au
References & links to more information:
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