Medical Manual 12th Edition

Effective July 2020Medical ManualEdition 12

COVID-19Resources for Airlinesand Air Transport ProfessionalsIn response to the unprecedented challenges currently facing the industry, IATA is stronglyadvocating for ICAO’s Takeoff Plan to restart aviation. The plan is designed to ease potentialconcerns associated with flying and encourage governments to reopen borders through aglobally harmonized approach.Working with global experts like the ICAO Council’s Aviation Recovery Taskforce (CART) and theWorld Health Organization (WHO), IATA has put together industry guidance covering airports,aircraft, passengers, crew and cargo, as well as analyses and forecasts of the economicimpact of COVID-19 on the industry, and summaries of the relief measures being rolled out bygovernments around the globe.This information is being updated often as conditions evolve and regulations change, so consultthe iata.org resources often!INDUSTRY GUIDANCEwww.iata.org/covid-19CART/IATA Guidance:Airport ICAO GuidelinesGround handling return to serviceGuidance for ground handling during COVID-19Ground Handling – information about conducting groundoperations in time of COVID-19Regulatory Approval Status for Mobile Boarding Pass, ElectronicBag Tag, Home Printed Bag TagAircraft ICAO GuidelinesCrew Guidance for crew health precautions during pandemicIATA Guidance for Managing Pilot Training & Licensing duringCOVIDCargo Aircraft cleaning & disinfection during & post-pandemicGuidance for cabin operations during & post-pandemic alsoavailable in SpanishICAO Guidelines Guidance for Flight Operations during and Post Pandemic ICAO GuidelinesCarriage of cargo in the passenger cabinGuidance for Operators of Dangerous Goods during COVID-19Air Cargo comprehensive FAQ on cargo operationsAirline Air Cargo Operations Status: this section covers over 370airlines worldwide, to capture the Operational Status, currentCargo Restrictions, Passenger to Cargo (“P2C”) & Cargo InCabin (“CIC”) informationCountry Air Cargo Operations Status: this section covers over200 countries, to capture the current Cargo Restrictions, CargoIn Cabin (“CIC) and other important updates to regulationsAir Cargo Schedules: this section will be released soon (plannedJuly 2020)Passenger Latest COVID-19 travel documentation requirements and healthrestrictions from around the world updated in real time:www.iata.org/timaticInstant updates of travel restrictions via Timatic COVID-19Alerts www.iata.org/timatic-alertsInteractive COVID-19 Travel Regulations Map provides thelatest travel restrictions per country via the IATA TravelCentre:www.iatatravelcentre.com/map

Government Measures Access the Government measures related to COVID-19 to learnout more about the entry/exit requirements as aviation headsinto a re-start phase (listed per country).COVID-19 Dashboard on state & airport restrictions (NOTAMand AIS data)COVID-19 Contingency related differences (CCRD) presentingalleviations in safety operational measuresRelief Measures for AirlinesIATA is appealing to governments for relief measures to supportthe industry in the face of collapsing travel demand, owing tothe COVID-19 pandemic and mandated border closures andrestrictions on mobility. See below areas of action:Industry ImpactData & Economic AnalysisAnalysis of COVID-19 impacts on the financial and trafficperformance and outlook for the global air transport industry.Economics All reports on COVID-19 published by IATA EconomicsCOVID-19 media kit Press Releases & SpeechesFinancial impactTraveler AdviceProfessional resourcesAirline TaxesCOVID-19 news – a collection of news stories from airlinesAirport Infrastructure & ChargesCommunication Materials Governments ticket tax change measures - tax relief measuresand payment deferralsAirport charges reduction - temporary reduction of airportcharges for airlines - per country, collected in our AviationCharges Intelligence Center (ACIC)COVID 19:Slots - to find outthe latest IATA’s position in the are of slotsRelief Measures News COVID-19 news a collection of news stories on governmentrelief measures as well as airport and airline newsIATA Position Papers Temperature Screening: A Public Health ResponsibilityCollection of Self-Declared Passenger Health DataHarmonization of Health Declaration Form/Data SetOther Guidance MaterialsSafety & Flight Operations Guidance for managing aircraft airworthiness for operationsduring and post pandemic Ed.1, 12 June 2020IOSA Guidance for Safety Monitoring under COVID-19 Ed.2IATA has launched a service for its member airlines thataddresses operational reports, questions and informationrelated to COVID restart operations: COVID Reporting Processfor Member AirlinesCustomer Vouchers Initiatives Airline vouchers & ticket exchange policies repositoryand airports as well as government relief measures.Communication Assets for Industry’s Re-StartAs the industry moves into the re-start phase following theCOVID-19 pandemic, IATA has developed infographics, visuals,and videos to help restore the travel confidence. Any industrystakeholder can download, use, and promote these assetsthrough their own communication channels as images arecopyright free.

NOTICEDISCLAIMER. The information contained in thispublication is subject to constant review in thelight of changing government requirements andregulations. No subscriber or other reader shouldact on the basis of any such information withoutreferring to applicable laws and regulations and/or without taking appropriate professional advice.Although every effort has been made to ensureaccuracy, the International Air Transport Association shall not be held responsible for any loss ordamage caused by errors, omissions, misprintsor misinterpretation of the contents hereof. Furthermore, the International Air Transport Association expressly disclaims any and all liability toany person or entity, whether a purchaser of thispublication or not, in respect of anything doneor omitted, and the consequences of anythingdone or omitted, by any such person or entityin reliance on the contents of this publication. International Air Transport Association. AllRights Reserved. No part of this publication maybe reproduced, recast, reformatted or transmitted in any form by any means, electronic ormechanical, including photocopying, recordingor any information storage and retrieval system, without the prior written permission from:Senior Vice PresidentMember & External Relationsand Corporate SecretaryInternational Air Transport Association33, Route de l’Aéroport1215 Geneva 15 AirportSwitzerlandMedical Manual, 12th EditionISBN 978-92-9264-250-1 2020 International Air Transport Association. All rights reserved.Montreal—Geneva

TABLE OF CONTENTSSECTION 1 – ROLE AND RESPONSIBILITIES OF AN AIRLINE MEDICAL SERVICE . 11.1Introduction . 11.2Potential functions of a Medical Service . 11.2.1Passengers Health . 21.2.2Occupational Health . 31.2.3Aircrew Health and Medical Certification . 51.2.4Alcohol and Other Drug Programs . 81.2.5Health and Wellbeing Promotion . 81.2.6Health Strategy and Risk Management . 91.2.7Primary Care Service . 11SECTION 2 – THE CABIN ENVIRONMENT . 122.1Introduction . 122.2Pressurisation . 122.3Ventilation . 132.4Contaminants . 132.5Temperature . 142.6Relative Humidity . 142.7Passenger Space Available . 142.8Noise and Vibration . 152.9Turbulence. 152.10Conclusion . 15References . 16Appendix ‘A’ . 18Figure 2.1 – Engine Bleed Air System . 18Appendix ‘B’ . 19Figure 2.2 – Physiological Impacts of Decreased Atmospheric Pressure . 19Appendix ‘C’ . 20Figure 2.3 – Ventilation System . 20Appendix ‘D’ . 21Figure 2.4 – Cabin Air Flow Pattern . 21SECTION 3 – CREW MEDICAL STANDARDS . 223.1Flight Crew Medical Standards . 223.1.1Rationale for Medical Standards . 223.1.2Environmental and Occupational Considerations . 223.1.3General and Specific Medical Considerations . 223.1.4Medical Standards . 233.1.5Selection and Initial Medical Examination . 23

Medical Manual3.23.1.6Responsibilities of Flight Crew . 233.1.7Responsibilities of the Airline Companies . 243.1.8Responsibilities of Authorised Medical Examiners . 24Cabin Crew Medical Standards . 243.2.1Cabin Crew Working Conditions . 243.2.2Aeromedical Assessment . 25SECTION 4 – OCCUPATIONAL HEALTH FOR AIR CREW . 264.14.24.34.4Sleep and Circadian Rhythms . 264.1.1Sleep Physiology . 264.1.2Alcohol . 274.1.3Sleepiness . 274.1.4Circadian Rhythms . 274.1.5Effect of Flight Operations . 284.1.6Strategies . 29Medication . 314.2.1Testing of Medication . 314.2.2Assessing Treatment Needs . 314.2.3Principles of Prescribing . 324.2.4Over-the-Counter Medications . 324.2.5Alternative Medicines . 32Travel Medicine . 334.3.1Principles of Risk Minimisation – Identification of Risk . 334.3.2Vaccinations and Travel . 334.3.3Important Diseases Associated with Travel . 344.3.4Environmental Issues . 354.3.5Jet Lag . 354.3.6Obligations of Airlines to Staff . 36Cosmic Radiation . 364.4.1Types of Radiation . 374.4.2Benefits and Risks of Radiation . 374.4.3Ionising Radiation on Earth . 374.4.4Cosmic Ionising Radiation . 384.4.5Measurement of Ionising Radiation . 394.4.6Exposure to Ionising Radiation . 394.4.7Radioactive Cargo . 404.4.8Occupational Exposure to Cosmic Radiation . 404.4.9Risks to Health . 414.4.10 Definitions . 42

SECTION 5 – AIRCRAFT OPERATIONS . 445.1Food and Hygiene . 445.2Disinsection . 445.35.2.1Importance of Aircraft Disinsection . 445.2.2Legal Situation . 455.2.3General Principles of Aircraft Disinsection . 455.2.4WHO Recommended Disinsection Procedures (update 1998). 465.2.5Considerations . 495.2.6Communication to Passengers and Crew . 49Cargo . 495.3.1Dangerous Goods . 495.3.2Emergency Treatment Following Exposure to Dangerous Goods Item . 505.3.3Storage and Handling of Toxic and Corrosive Materials . 515.3.4Transport of Dangerous Goods by Air . 51SECTION 6 – PASSENGER CARE . 526.16.26.3Fitness to Fly . 526.1.1Responsibility for Medical Clearance . 526.1.2General Guidelines for Medical Clearance . 526.1.3Passenger Categories . 526.1.4Logistics of Medical Clearance . 536.1.5Special Services .

IATA Guidance for Managing Pilot Training & Licensing during COVID Cargo ICAO Guidelines Carriage of cargo in the passenger cabin Guidance for Operators of Dangerous Goods during COVID-19 Air Cargo comprehensive FAQ on cargo operations Airline Air Cargo Operations Status : this section covers over 370