FIRST CLASS MEDICAL (INITIAL / REVALIDATION / RENEWAL)

Examinations
lf you want to obtain a commercial pilot license, are currently training for one, or already hold one, you need a Class 1 medical certificate.

Initial examination
The initial examination must be carried out at an Aero Medical Center and always includes:
• Collection of medical history using the application for the issuance of a medical fitness certificate (this can already be      completed online at horne)
• Physical examination
• Laboratory testing of blood and urine
• Heart EGG, echocardiography if required, and further examinations
• Pulmonary function lest
• Ophthalmological examination
• Colour vision (MED.B.075)

The Aeromedical Center Germany works with the CAD test. This test allows objective statements to be made about color vision, both for pilots and air traffic controllers.

The CAD test is recognized internationally by EASA, the German Federal Aviation Authority, the FAA (USA), and others. The test evaluates automatically, and these evaluations are accepted by the authorities.
The system is also applicable to occupational medicine and to transport medicine as a whole (e.g., rail, shipping, and road transport).

This test was developed by Prof. Barbur from the University of London (the Aeromedical Center Germany is participating in a scientific study on this topic).

Colour Vision Assessment - the CAD test
The CAD test screens for normal red/green (RG) colour vision in less than one minute. lf lass of RG colour vision is detected, the program can be used to measure accurately the severity of RG colour vision lass and to diagnose the class of deficiency involved (i.e., protan- or deutan-like deficiency) in 9 minutes.
The CAD test can measure very small changes in the patient's chromatic sensitivity over time and this can be used to detect and then to monitor progression of disease and/or effects of treatment.

The CAD also tests for yellow/blue (YB) deficiency. Subjects born with congenital yellow/blue (YB) are very rare (about 1 in 20,000), but the prevalence of acquired YB sensitivity is much higher and increases with age.
The presence of acquired lass of YB chromatic sensitivity can be detected with high sensitivity and the severity of colour vision lass can be quantified accurately in 3 minutes. YB lass is often associated with systemic and/or eye disease.

Preliminary data suggests that in cases of ARMD and diabetes, the lass of chromatic sensitivity can be severe and often precedes early clinical signs of retinopathy, in some cases by several years.
The Colour Assessment and Diagnosis (CAD) test was then developed further with support from aviation authorities and Transport for London and is the most researched and documented AVOT test.
The CAD test has now become the 'gold standard' for detection of congenital and acquired deficiencies and for establishing the severity of colour vision lass.

li) Applicants who do not pass the lshihara lest shall be referred to the medical assessor of the competent authority and must undergo further colour vision testing in order to demonstrate colour-safe vision.

ii) Applicants must be normal trichromats or colour-safe.
iii) Applicants who do not pass the further colour vision tests shall be assessed as unfit. 

Aeromedical Center Germany uses the CAD test as an advanced colour vision lest.

• Ear, nose and throat examination (ENT)
For applicants applying for a medical fitness certiflcate for the first time, the hearing loss measured separately in each ear by pure-tone audiometry must not exceed 35 dB at a frequency of 500 Hz, 1,000 Hz or 2,000 Hz, and must not exceed 50 dB at a frequency of 3,000 Hz.

Mental health (MED.B.055)
a) As part of the initial aeromedical examination for the issuance of a Class 1 medical fitness certificate, a comprehensive assessment of mental health shall be carried out.
b) As part of the initial aeromedical examination for the issuance of a Class 1 medical fitness certificate, a drug and alcohol screening shall be performed.
• Final aeromedical consultation
lf any abnormalities are found, further examinations may be necessary.

Renewal examination
The renewal examination is carried out according to reduced criteria.

What to bring along for examination
• ldentification card
• Existing licenses
• Previous certificate (for renewal examination)
• Glasses prescription
• Hospital or doctor's reports for pre-existing conditions

Validity period and examination intervals 

Medical Class 1
• 12 months
•  6 months from reaching the age of 60
•  6 months from reaching the age of 40 if single commercial pilot passenger transportation

Procedural instructions RXO entries
RXO = regular eye examinations required. lf the diopters exceed certain limits, regular eye examinations must be carried out. This must be specified by entering RXO in the medical certificate.

The following values apply:
• between +3.0 and +5.0 diopters
• between -3.0 and -6.0 diopters
• Astigmatism and/or anisometropia between 2.0 and 3.0 diopters
With these values, an eye examination must be performed every five years.
• Refractive error > 6.0 diopters
• Astigmatism and/or anisometropia > 3.0 diopters

With these values, an eye examination must be performed every two years.

Since the fitness certificates are printed using the Federal Aviation Authority's transmission program (EMPIC), we must have the RXO entry approved by submitting the results of an eye examination.
Approval takes one to two days, which means we cannot issue the certificate immediately.

Referral
lf the applicant does not meet the required minimum standards, the matter must be referred to the Federal Aviation Authority in accordance with the implementing regulation. The aviation medical examiner draws up a list of requirements specifying the necessary conditions and follow-up examinations.
This proposal will be submitted to the Federal Aviation Authority as a proposal, and then we must wait for the authority's approval. The certificate of fitness will be issued by the AME after getting the permission from the authority.