Medical Perspectives for Aircrew

30/08/2024

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11/05/2024

Medical conference on Cancer in Berlin - Germany was held recently. the key points for all to consider were:-
1. Do not use oil that has been heated once. throw it away.
2. No to powdered milk.
3. No to Maggie soup cubes
4. No to carbonated juices and sodas. ( Contains 32 sugar cubes per litre)
5. No processed sugars eats
6. No prenatal mammograms
7. Do not wear too tight bras
8. No to smoking
9. No to binge drinking or consuming more than two 30ml drinks.
10. Do not reheat frozen meals
11. Do not use plastics - bottles, cups etc. when plastic comes in contact with heat it produces several carcinogenic chemicals.
12. Cancer cells require sugar to multiply rapidly and grow. If one abstains from sugar intake, the disease recedes.
13.do not consume processed foods especially meat products.
Do's
1. Do consume Fruits and vegetables.
2. keep yourself well hydrated
3. Consume honey instead of sugar
4. Eat freshly cooked food. If you need to reheat use oven top. do not use microwave.
5. Exercise regularly.
6. Anti Cancer Juice - Aloe vera + Ginger + Parsley + Celery + Pineapple. Mix and drink on empty stomach. ( I personally cannot vouch for this juice, it has been recommended by some oncologists).
Basically stay happy and try to do your best, in regards, to the above recommendations.

11/05/2023

I shall be collaborating with a health care company to make videos on Aircrew Health issues. Please give me your inputs on what topics I should address at the onset.
Your inputs would be invaluable to me.
Regards

23/02/2023

The latest initiative taken by DGCA in implementing mental health care is a step in the right direction. In fact it was long overdue. The emphasis still put by regulatory authorities on physical standards on weight, BP, blood sugar levels, Lipid profile etc. is outdated The level of health care available across our country to the aircrew and their own awareness of maintaining good health has brought about a paradigm shift in annual license medical examination. Rarely did I find a ‘New” illness in a pilot for class 1 renewal medical. Either it was detected by lab tests or most of the times pilot declared himself. Clinical examination did not add much value. The need for today and future is mental well being of the aircrew. The aircrew are representatives from todays society and hence have similar issues as general public, same strains and stresses. Hence the earlier step of starting drug testing of pilots along with alcohol testing and current proposal of monitoring mental well being and initiating proactive steps in a timely manner is the right approach.
Alcohol & Drug Testing along with mental health monitoring DGCA has given the responsibility to the airlines and other non scheduled operators. I Strongly feel that even the license medical examinations should be given the Airline medical departments. I do not feel there is any clash of interests or dichotomy. The airline doctors will perform their duties with as much diligence they have shown in implementing the DGCA Alcohol and drug policy. Which I think is running quite efficiently. This was early on within the purview of the airlines, but in the west, airline medical directors, to reduce their work outsourced it and gradually lost their entire departments. When I was in UAE, both Emirates and Etihad played both roles of regulators and health care providers efficiently and with probity. For those who cannot access airline medical departments, IAF Medical establishments in various parts of India should be available to them. All appeal cases to AFCME/IAM.To my mind a well established airline medical department /AAI medical departments for ATCOs with requisite aviation medicine specialists is the way forward.
At DGCA I recommend only serving IAF aviation medicine specialists. I recommend two verticals, each under Group Captain, one looking after license medical examinations, as they are going to increase incredibly fast in India. Second Vertical to look after policies, implementation and training and audit of Airline medical departments.

21/09/2021

A new draft circular on drug testing of aircrew has been issued by DGCA. I have appended below. Please give your suggestions/comments for discussion with DGCA.
"1
GOVERNMENT OF INDIA
OFFICE OF THE DIRECTOR GENERAL OF CIVIL AVIATION
TECHNICAL CENTRE, OPP SAFDURJUNG AIRPORT, NEW DELHI
CIVIL AVIATION REQUIREMENTS
SECTION 5 - AIR SAFETY
SERIES F PART V
ISSUE I, DATED ___ EFFECTIVE:
File No.DGCA.15032 (02)/2/2020-DAS
SUBJECT: Procedure for examination of the aviation personnel for
consumption of Psychoactive Substances.
1. Introduction
1.1 The worldwide spread of use of psychoactive substances, their general
availability and the ever-increasing number of addicted users is a serious
concern to aviation safety. Their use causes behavioural, cognitive and
physiological changes. This manifests in dependence, major health related
issues and negative effect on performance.
1.2 Ministry of Social Justice and Empowerment, Government of India has carried
out a study on the extent of the prevalence of this disorder amongst general
Indian population and published a report in Feb 2019. The report reveals the
following facts:
 After Alcohol, Cannabis and Opioids are the next commonly used
psychoactive substances in India. About 2.8% of the population had used
any cannabis product within the previous year.
 About 0.25% (one in eleven Cannabis users) suffer from Cannabis
dependence.
 About 2.1% of the country’s population use opioids which includes O***m
and its various variants, He**in (or its impure form – smack or brown sugar)
and a variety of pharmaceutical opioids.
 Nationally, the most common opioid used is He**in (1.14%) followed by
pharmaceutical opioids (0.96%) and O***m (0.52%). About 0.70% of
Indians are estimated to need help for their opioid use problems.
1.3 Considering the National data, there is a potential for the use of psychoactive
substance in the society, impacting the safety in Civil Aviation. Therefore
there is a need for setting up a preventive mechanism. This Civil Aviation
Requirement lays down the procedure for the identification of the aviation
2
personnel indulging in use of the psychoactive substances and action on
such aviation personnel.
1.4 Para 1.2.7.1 of ICAO Annex -1 states that “Holders of licences shall not
exercise the privileges of their licences and related ratings while under the
influence of any psychoactive substance which might render them unable to
safely and properly exercise these privileges”.
The Federal Aviation Agency, USA and European Union Aviation Safety
Agency (EASA) have also developed and published their policy for detection
of consumption of psychoactive substance by personnel engaged in safety
sensitive functions.
1.5 This CAR is issued under the provisions of Rule 24 read with Rule 133A of
the Aircraft Rules, 1937.
2. Definitions:
2.1 Appropriate Laboratory: NABL approved pathological laboratory having
technical capability and skilled manpower for collection of the samples,
maintaining its integrity, ensuring Chain of Custody of samples, preservation
and conducting requisite examination for detection of consumption of
psychoactive substance.
2.2 Drug Abuse: It is an improper use of a therapeutic or non-therapeutic drug
resulting in impulses to use that leads to significant problems and distress.
Drug Abuse arise out of a maladaptive pattern of substance abuse,
manifested by recurrent and significant adverse consequences related to the
repeated intake of the substance. Repeated Drug abuse can lead to
addiction or drug dependence.
2.3 Drug Dependence: Arises out of maladaptive pattern of substance use,
leading to a cluster of behavioural, cognitive and psychological phenomena
that develops after repeated use.
2.4 Drug Addiction: it is a chronic, relapsing disorder characterized by
compulsion to take a drug (craving), resulting in physical, psychological and
social harm and continued use despite evidence of that harm.
2.5 Drug Habituation: It is a condition resulting from repeated consumption of
a drug, in which there is a psychological or emotional dependency on the
drug.
2.6 Sample Collector: An employee of an appropriate laboratory who is skilled
for collection of the samples, maintaining its integrity, preservation and
examination for detection of consumption of psychoactive substance.
3. Applicability
Provisions of this Civil Aviation Requirements are applicable to aircraft
operators engaged in commercial operations, Maintenance & Repair
Organizations, Flying Training Organizations and Air Navigation Service
Providers.
3
4. Safety Regulations:
4.1 All scheduled commercial aircraft operators and Air navigation service
provider shall carryout, random drug testing for the consumption of
psychoactive substance of flight crew members and Air traffic controllers
employed by them respectively at the facilities established by them using the
services of an appropriate laboratory. The medical personnel of the
concerned Organization shall associate during this process. This
programme shall ensure that at least 5% of the employees of an
organization, as mentioned in para 4.1 of the Civil Aviation Requirements,
are covered in a year.
The Organizations shall use a scientifically valid method such as a randomnumber
table or a computer-based random-number generator to select the
employees for testing using the unique identifying number. The Organization
must ensure that all employees have an equal chance of being tested each
time the selection is made. Specific individuals or groups must not be
targeted including certain locations.
4.2 All organizations as in para 3 are encouraged to carry out random drug
testing of their employees not covered in para 4.1 and trainee pilots in case
of FTOs.
4.3 In addition, the Organizations as mentioned in para 3, shall ensure that Flight
Crew Member, Air Traffic Control Officers, Aircraft Maintenance Engineers/
certifying staff, trainee pilots and Instructors/examiners in their employment
are tested for detection of drug abuse /habituation/Dependence /Addiction
on the following occasions:
a) Before employing a person
b) Before admitting a trainee pilot in a FTO
c) Follow-Up testing of confirmed cases.
d) At first available opportunity, in case an aviation personnel has
refused drug test to a foreign regulator during flight operation to that
country/duty in that country.
4.4 All the positive cases shall be reported by the organization to DAS, DGCA
(HQ) within 24 hours. In addition the information shall also be submitted to
DDG/JDG Air Safety and DMS (CA).
4.5 Organizations as in para 3, should encourage their employees for selfdeclaration
regarding use of psychoactive substance. Such employees shall
be subjected to rehabilitation process by the organization before return to the
active duty. Number of such cases shall be reported to DGCA on six months
basis.
4.6 Organizations as in para 3, shall educate their employees about the
prescription drugs that contain substances listed in para 5 of this CAR.
5. Drug Testing Requirements:
The following psychoactive substances shall be tested:
a. Amphetamine
b. Methamphtamine
c. Cannabis
4
d. Co***ne
e. Opioids
f. Barbiturates
g. Benzodizipine
h. M**A or Ecstasy
6. Procedure for Testing of psychoactive substances(Drugs)
6.1 Testing will be done on urine samples collected from the randomly selected
employees. The urine samples shall be collected at the designated secure
facility established by the organization. Samples shall be collected only with
consent of the person required to undergo test in the proforma provided as
Appendix ‘A’ to the CAR.
6.2 The collection site must be well lit, clean, free of any areas where
adulteration or substitute can be hidden, eliminate or secure all sources of
water, detergent, soap dispensers or any potential adulterants in the area.
The facility shall be examined by the organization’s medical personnel and
sample collector, before commencement of the sample collection.
6.3 The test shall be carried out post flight/post shift or anytime during the duty
period as the case may be. It shall not be carried out while an employee is
on leave or on rest period.
6.4 Prior to collection, the sample collector shall ensure that the identity of the
employee undergoing the testing is well established and the personal
particulars form is filled up as in Appendix A.
6.5 The sample is to be collected in a clean, sterile and unused sealed
container. At least 30 ml of urine sample needs to be collected each in two
bottles labeled specimen A and B. Labels of specimen bottles shall be
signed by the employee (donor), sample collector and medical personnel
of the concerned Organization before the samples are collected.
6.6 The employee (donor) shall be provided privacy for sample collection.
6.7 Screening and confirmatory test will be done on urine samples. The
screening test shall be carried out immediately after the sample is collected
at the designated facility of the organization and report shall be generated.
Screening test on the sample shall be carried out in a room equipped with
video recording facility. The employee undergoing testing will wait in a
designated area for the report.
6.8 In case sample A is positive, then sample B with signatures of the sample
collector, employee (donor) and medical personnel of the concerned
Organization shall be forwarded to the appropriate laboratory for
Confirmatory Test.
7. Confirmatory Test:
The confirmatory test shall be carried out at appropriate laboratory. During
transportation of the sample, the integrity of the sample shall be ensured at
every step including temperature control. The laboratory shall maintain
integrity of the samples and also maintain the chain of custody of the samples.
In the laboratory sample shall be tested for all the drugs as listed in para 5 and
5
the report from the laboratory shall be sent directly to the Medical In Charge
of the concerned organization and Director Air Safety, DGCA (HQ). In case
the confirmatory test is found positive, a portion of the sample B shall be
preserved in the appropriate laboratory for twelve months.
8. Action on Positive Cases
8.1 In case the screening test is positive, the employee shall be immediately
removed from the safety sensitive duty till a confirmatory report is received.
8.2 In case of positive confirmatory test for the first time, the concerned
employee shall be referred by the organization to a de-addiction center for
de-addiction/rehabilitation programme as applicable. Such an employee
shall return to active duties after again having undergone the tests for the
consumption of the psychoactive substance with a negative test report. In
addition clearance by treating Psychiatrist and the certification by the
Medical In Charge of the concerned organization shall be required.
8.3 In case a person who has returned to safety sensitive duties after having
been tested positive as in para 8.2 and is again found positive in the
confirmatory test i.e. the second occasion, license of such person shall be
suspended for period of three years and for third positive occasion, the
license shall be cancelled.
8.4 In the event, if a person refuses to undergo the examination, such a person
shall be removed from the safety sensitive duties until such a person clears
drug testing profile as listed in para 5 within a period of three days at the
organization facility. Failing which, the license of the involved person shall
be suspended for a period of one year and the involved person shall
undergo rehabilitation process before return to the active duties.
8.5 In case a person refuses for the test on second occasion or is tested positive
after first occasion of refusal for testing, the license shall be suspended for
a period of three years and any subsequent violation shall lead to the
cancellation of license.
9. Disposal of Cases involving Disagreement
DGCA shall nominate a Medical Review Officer (MRO) having detailed
knowledge of substance abuse disorders. In case of any disagreement, if
considered necessary, DGCA may refer the matter to the MRO for advice.
10. Preservation of records:
The organization shall preserve test records of psychoactive substances for a
period of one year.
(Arun Kumar)
Director General of Civil Aviation
6
Appendix A
(NAME OF THE ORGANISATION)
CONSENT FOR MEDICAL EXAMINATION FOR PSYCHOACTIVE SUBSTANCE
Sl. No. …………………
SCREENING TEST
To be filled by Pilot/ATCO (in Capital Letters)
Name ………………………Job Function:…………………………..
Personnel (License No. /Approval No.) ………................................
Emp. No. …………….
Are you on any medication? If yes, please specify………………………………….
Place …………… Date …………… Time……………….
Signature of Employee………………………..
To be filled up by the Sample Collector
1. Urine test Outcome Negative/Positive
(Signature)
(Name)
2. If the Screening Test is Positive:
Ensure sample B is sealed and the label is signed
Signature
Medical Personnel of
Organization
Name and designation
Date/Time
Signature Signature and
Name of Sample Name of Person
Collector undergoing test
Date/Time Date/Time

20/07/2021

Dear Colleagues DGCA has started eGCA medicals over last few months and shortly will stop hard copy medicals in toto. Observing some issues that pilots are encountering commonly, I thought it might be useful to give some guidance.
1. All pilots need to have an eGCA ID.
2. After creating ID Log in with same and Password.
3. Left hand there will be list of options - go to MEDICAL.
4. Under Medical Click on class 1 Renewal or class 2 Initial whichever is applicable.
5. Screen will open 'option to track status' click OK
6. Click on class 1 renewal or class 2 initial as applicable
7. New screen - Fill basic details. Kindly ensure all details are filled specially employer and last medical details.
8. Upload Photo - JPG, Full screen shot. Photo should have name of pilot and date of photograph printed on it.
9. Click Next - Medical Declaration page. complete and click submit.
10. Medical Investigations & reports upload page will open. Best would be to make a single document of all investigations and reports. Reports must be from NABL/NABH approved clinics/Labs only. All investigations listed on this page have to be submitted. Do Not exercise your common sense that I did it last time or as per AIC its not needed. Whatever investigation is mentioned there HAS to be done and ticked.
If any additional investigations /reports have been asked during previous medical, then it must be ticked under 'other' and uploaded.
Sometimes during special medical there is a last investigation for those pilots who have undergone CABG. It needs to be ticked done. Its not needed to be done but tick is needed. else cannot submit the medical. Its a flaw which will be corrected in due course. for now tick as done. AME will clarify it on the Medical examination page.
Show your investigation reports to your AME before uploading it.
click submit
11. You will be guided back to 'Track Status'. Again revalidate the medical declaration. The revalidation has to be done on the day of the medical ONLY. Do not revalidate previous day and come next day. REVALIDATE SAME DAY OF MEDICAL.
12. If all successful you will get a message application submitted go to your AME for medical.
13. Those who wear glasses must bring their eye prescription, ophthalmic examination report.
I hope the above information will help you all in completing the medical in a smooth manner. Happy landings!

24/05/2021

A new circular has been issued by DGCA dated 01 Jul 2021. the concessions of conducting medicals with AMEs granted from April 2021 to 30 Jun 2021 has been extended upto 31 Oct 2021.

08/04/2021

A New circular dated 05 April 2021 has been issued by DGCA regarding amendment to CAR 7 - Medical Standards.
The gist of it is:
1. Special age related Class 1 medicals at ages 25, 30 ,35 & 40 can henceforth be conducted by class AMEs. Thereafter at IAF boarding centres.
2. Special Class 1 license renewal medical, post a period of unfitness not exceeding 60 days, can also be done by class1 AME after obtaining permission from DGCA(like currently we do post covid unfitness).
3. ATCOs also brought under the purview of DGCA Class3 Medicals. Now to be conducted by AMEs on CA 34 & 35 like aircrew.
I think its a good development. Stay safe and healthy. Continue Covid appropriate behaviour, Take your vaccination as & when your turn comes.

12/03/2021

Air Crew are always trying to control diet, before their annual medical. Here is some advice for you all:-
1. Control your diet through out the year, not one month before medical. It's the quantity which matters.

2. *Eat fruits grown locally* ..... Banana, Grapes, Chikoo, Mangoes. All fruits have FRUCTOSE so it doesn't matter that you are eating a mango over an Apple. A Mango comes from Konkan and Apple from Kashmir. So Mango is more local to you.
*Eat all the above fruits in DIABETES as the FRUCTOSE* will eventually manage your SUGAR
2. Choose Seed oils than Veggie oils. Like choose ground nut, mustard, coconut & til. *Don't choose chakachak packing oils*, like olive, rice bran etc
*Go for kachchi ghani oils than refined oils*
*Eat GHEE daily*. How much GHEE we should eat depends on food. Few foods need more GHEE then eat more and vice versa. Eat ample *GHEE. It REDUCES cholesterol*.
4. *Include COCONUT.* Either scraped coconut over food like poha, khandvi or chutney with idli and dosa
Coconut has *ZERO CHOLESTEROL* and it makes your WAIST SLIM
5. *Don't eat oats, cereals for breakfast*. They are packaged food and we don't need them. Also they are tasteless and boring and our day shouldn't start with boring stuff. Don't chose them for fibre. *Instead of oats, eat poha, upma, idli, dosa*
7. *No JUICES till you have teeth* in your mouth to chew veggies and fruits
8. *SUGARCANE is the real DETOX* . Drink the juice fresh or eat the SUGARCANE
9. For pcos, thyroid - do strength training and weight training and avoid all packaged food
10. *RICE - eat regular WHITE RICE. NO NEED of Brown rice.* Brown rice needs 5-6 whistles to cook and when it tires your pressure cooker, then why do you want to tire your tummy.
A white rice is hand pounded simple rice
*Rice* is not high is GI INDEX. Rice has mediun GI index and by eating it with daal / dahi / kadhi we bring its GI index further down
If we take _ghee over this daal chawal then the GI INDEX is brought further down._
*B.* Rice has some rich minerals and you can eat it even three times a day
11. How much should we eat - *eat more if you are more hungry,* let your stomach be your guide and vice versa
12. We can *eat rice and chapati together* or only rice if you wish. It depends on your hunger. *Eat RICE in ALL THREE MEALS without any fear.*
13. Food shouldn't make you scared like eating rice and ghee. *Food should make you FEEL GOOD*
14. *NEVER* look at *CALORIES*. Look at *NUTRIENTS*
15. *No bread, biscuits, cakes, pizza, pasta*
16. Ask yourself is this the food my parents & Grandparents ate? If yes then eat without fear.
17. Eat as per your season. *Eat pakoda, fafda, jalebi in monsoon*. eat, sarson ka saag with white butter in Winter, Your hunger is as per season. Few seasons we need fried food so eat them.
18. When not to have chai - tea - don't drink tea as the first thing in morning or when you are hungry. Rest you can have it 2-3 times a day and with sugar
19. *NO GREEN tea please.* No green, yellow, purple, blue tea.
20. Eat *ALL* of your *TRADITIONAL* foods.
21. Strictly *NO* to packaged foods / drinks.
22. *Exercise / Walk*
to digest & stay healthy.

10/03/2021

Recent Post Vaccination guideline from DGCA.

16/12/2020

DGCA has issued a letter authorising AMEs to continue doing special medicals (25 - 65 years) of age till 30 Jun 2021. However the difference this time from earlier authorisation is that now all age related tests have to be done too and not left for next review. Aircrew coming for medicals hence forth please note.
for Post Covid medicals - requirements are Letter from company doctor detailing the clinical course and fitness, letter from DGCA authorising medical review by AME, reports of investigations conducted, Prescription of any medicines taken during the period of quarantine.