Flight Medicine — Lakeshore Physicians Walk-In and Family Practice

Air Factor Definitions (AMA 100-01)

The Air Factor identifies the functional capacity of aircrew and communicates medical fitness status. A1-A4 are aircrew factors; A5-A6 are passenger factors; A7 indicates grounded status.

Air Factor	Definition	Applies To
A1	Medically fit for unrestricted duties	Pilots (MOSID 00183)
A2	Medically fit for unrestricted duties in air operations	ACSO, Flight Engineers, AESOp, FTE, Mission Specialists
A3	Medical operational flying or flight controlling restriction The specific restriction must be defined as part of the A3 (Medical Employment Limitations)	Any CAF aircrew with restrictions
A4	Medically fit for specific aircrew duties	SAR Specialists, AEC, AC Op, Loadmasters, Flight Stewards, AMTO, AvPhys Tech, Flight Surgeons, Flight Nurses, Flight Paramedics
A4 WSE	Temporary A4 (While So Employed) for designated period of aircrew duties	Flight Attendants, ASI Op, HSI Op, AWACS-ATIS Technicians
A5	Medically fit to fly as passenger in CAF aircraft	Non-aircrew CAF personnel
A6	Unfit to fly in CAF aircraft	CAF personnel unfit for any flight
A7	Medically unfit to carry out MOSID-specific aircrew duties Grounded but typically may still fly as passengers (unless specifically restricted)	CAF aircrew who are grounded

Aeromedical Risk Matrix (AMA 100-01 Annex B)

The risk matrix combines likelihood of medical events with consequence severity. Risk increases toward upper right. Green = Low risk (generally acceptable), Yellow = Moderate risk (may require restrictions/mitigation), Red = High risk (generally requires grounding).

Event Class Definitions

Class 1 - Minimal Impact

Minimal/no mission impact
Low effect on performance
Routine medical follow-up

Class 2 - Mission Abort

May result in mission abort
Moderate performance effect
Requires post-mission medical

Class 3 - Flight Safety Hazard

Flight safety hazard likely
Major performance decrement
Requires immediate medical

Class 4 - Critical Event

Flight safety critical event
Total incapacitation
Requires advanced medical

Aircrew Risk Matrix

Likelihood	Class 1	Class 2	Class 3	Class 4

Category 1

Pilots – Fighters, Tactical Helo, Maritime Rotary Wing, SAR rotary wing, Instructors of pre-wings students; SAR Technicians

Category 2

Pilots – Transport, Maritime Fixed Wing, SAR Fixed Wing, Instructors of post-wings students

Category 3

Non-pilot Group A – ACSO, FE, AESOp, MS, FTE, LM, AEC, ACOp (DCP), AMTO (chamber), Aeromed Tech, UAV Tier 1/2

Category 4

Group B – Flight Surgeon, Flight Nurse, Flight Med Tech, Flight Steward, Flight Attendant, AWACS/ATIS, UAV Payload Ops

Categories 2–4 have progressively more tolerance for risk (more green cells) because medical events in these roles have less direct impact on flight safety compared to Category 1.

Risk Mitigation Strategies

High Risk → Ground

Temporarily (until condition improves) or permanently. Period of grounding for observation may allow better definition of long-term risk.

Moderate Risk → Restrict

Assign A3 Air Factor with specific operational restrictions designed to mitigate medical risk (e.g., "with or as co-pilot").

Medical Intervention

Use of medications or treatments to reduce risk of medical event. With treatment, risk may be reassessed to lower level.

Aircrew Group Classifications (AMA 100-01 Table 2)

Aircrew occupations are divided into Group A and Group B based on flight safety implications. Group A aircrew require annual PHAs; Group B aircrew require PHAs every 5 years (under 40) or every 2 years (40+).

Group A Aircrew

Pilot
Air Combat Systems Operator (ACSO)
Flight Engineer (FE)
Loadmaster (LM)
Airborne Electronic Sensor Operator (AESOp)
Aerospace Controller (AEC)
Aerospace Control Operator (AC Op) – DCP only
Aeromedical Training Officer (AMTO)
Aviation Physiology Technician (Av Phys Tech)
Search and Rescue (SAR) Specialist
Mission Specialist
Flight Test Engineer (FTE)

Group B Aircrew

Flight Surgeon (FSurg)
Flight Nurse
Flight Paramedic
Flight Steward
Flight Attendant (WSE)
Airborne Signal Intelligence Operator (ASI Op) (WSE)
Hyper Spectral Imaging Operator (HSI Op) (WSE)
AWACS-ATIS Technician (WSE)
Aerospace Control Operator (AC Op) – non-DCP

WSE = While So Employed (temporary A4 for designated period)

Pick your pathway

Scenario

Pipeline stage (candidate)

Aircrew group (PHA)

Age band (Group B)

Assessment type (PHA)

Medical issue category

Optional flags

Outside standard OR expected >3 months impact

Considering Air Factor validity extension

Local provider

Output

Copy output is clean text suitable for a note/email. References: AMA 100-01, FSG 100-01/02, FSG 300-01, FSG 600-01/02, FSG 900-01, FSG 1000-01, FSG 1200-01, FSG 1400-01/02/03, FSG 1900-01.

Aircrew Visual Requirements (FSG 400-01)

Comprehensive visual standards for CAF aircrew. Reference: FSG 400-01, AMA 100-01, AMA 400-02. Last reviewed: October 2024.

Visual Acuity Standards by Category

Measurement	V1 Pilots (uncorrected)		V2 Pilots & SAR		V3 Other Aircrew		V4 Flight Surgeon
Measurement	Better	Other	Better	Other	Better	Other	Better	Other
Distance Vision
Uncorrected	6/6	6/9	6/18 or 6/12	6/18 or 6/30	6/60	6/60	N/A
Corrected	N/A		6/6	6/9	6/6	6/9	6/9	6/60
Near Vision @ 30-50 cm
Uncorrected	N5	N6	N10 or N8	N10 or N12	N/A		N/A
Corrected	N/A		N5	N6	N5	N6	N6	N36
Near Vision @ 100 cm
Uncorrected	N14	N18	N24 or N16	N24 or N36	N/A		N/A
Corrected	N/A		N14	N18	N14	N18	N18	N36

Note: V1 pilots must meet uncorrected vision standards; V2 pilots and SAR can meet standards with correction. V5 is not included as it is not typically compatible with any aircrew duties.

Refractive Error Limits

Spherical Equivalent (SE) = 1/2 cylinder + sphere

Group A Aircrew

SE > -8.00 D or > +3.00 D is disqualifying
SE > -6.00 D requires dilated retinal exam
Can consider refractive surgery for SE -8.00 D to +3.50 D
Retinal lattice is disqualifying

Group B Aircrew

SE > -8.00 D with retinal pathology is disqualifying
SE > +5.00 D is disqualifying
Without retinal pathology, pre-op SE may exceed -8.00 D if corrected by acceptable surgery

Eye Examination Periodicity

Initial Aircrew

Full aircrew eye exam including cycloplegic refraction required within 12 months before CFEME review
Colour vision testing required only at initial PHA
DND 2776 form must be used

Group A Aircrew (after initial)

Every 4 years after initial exam until age 40 (every 2 years if using corrective lenses)
Every 2 years after age 40
Increased frequency for clinical conditions (e.g., glaucoma suspect, diabetes)

Group B Aircrew (after initial)

Eye examination with each PHA per CFHS Instruction 4000-01
Colour vision testing NOT required for subsequent PHAs unless clinical concern

Ocular Conditions

👁️ Ocular Muscle Balance ▼

Diplopia in any field of gaze is DISQUALIFYING

Deviation Type	Limit	Notes
Vertical (hyperphoria/hypophoria)	< 2 prism diopters	At both 30-50cm and 6m
Horizontal (exophoria/esophoria)	Up to 10 diopters	Acceptable if no history of diplopia

🔍 Keratoconus (KC) ▼

Keratoconus is progressive non-inflammatory thinning and distortion of the central cornea.

Untreated KC or suspicious corneal changes are NOT accepted for aircrew

Acceptance after Collagen Cross-Linking (CXL):

Stability demonstrated on two post-op corneal tomography exams, 12 months or more apart
No increase in Kmax >1D, astigmatism >0.5D, or myopia >0.5D SE
Meet visual standards with glasses
Unfit if: post-op Kmax >58D or corneal thickness <400um

📊 Intraocular Pressure (IOP) / Glaucoma ▼

Glaucoma Suspects - Refer to Ophthalmologist if:

IOP in either eye >22 mmHg
IOP difference of 4 mmHg or more between eyes
Pigmentary dispersion syndrome or narrow angles
Suspicious optic nerve cupping or visual field defects

Treated Glaucoma: Aircrew with controlled IOP and no significant field loss may be fit for unrestricted duties. Assign MEL: G3. Route via 1 CAD Surg/ASCS.

🩻 Retinal Conditions ▼

Lattice + Myopia > -6D SE = UNFIT for aircrew duties

Other Disqualifying Retinal Conditions:

History or evidence of retinal detachment
Retinal hole with evidence of fluid or vitreous traction
Central or peripheral retinal degeneration/dystrophies
Central Serous Chorioretinopathy

Corrective Lenses & Surgery

👓 Spectacles & Lenses ▼

Permitted Spectacle Lenses

Type	Status	Grounding	Notes
Bifocals, Trifocals, Progressive Lenses	✓ Acceptable	7 days (first pair)	For aircrew requiring near and distance correction. Allows adaptation to focal distances and illusory movement.
Change from multifocal to progressive	✓ Acceptable	7 days	Same grounding required as first-time multifocal/progressive

NOT Permitted for Aircrew

Type	Status	Reason
Polarized Lenses	✗ NOT Permitted	Prohibited for any aircrew duties
Transition (Photochromic) Lenses	✗ NOT Permitted	Prohibited for any aircrew duties
Contact Lenses (medically required)	✗ Disqualifying	Medically required use of a contact lens is a disqualifying condition

Return to Flying with New Multifocal/Progressive Lenses

Prior to return to flying after the 7-day grounding period, a functional assessment is required:

Ground check in the aircraft – assess adaptation, fit with other gear, and effective vision correction
In-flight assessment – if ground check successful (simulator acceptable if available)
Non-safety-critical flight – at least one flight on their specific platform in non-safety-critical role

Assessment should include a range of flight conditions (VFR/IFR approaches for pilots), use of all visual display systems, and evaluation of distance vision especially when landing. If functional assessment suggests problems, consult optometrist for possible lens design change.

✨ Laser Refractive Surgery (LRS) ▼

Permitted Procedures

Procedure	Status	Return to Duty
PRK	✓ Permitted	3 months (myopia/astigmatism), 6 months (hyperopia)
LASIK / SBK	✓ Permitted	6 weeks (myopia/astigmatism), 4-6 months (hyperopia)
SMILE	✓ Permitted	3 months

NOT Permitted

Radial Keratotomy (RK)
Intrastromal Corneal Ring Segments (ICRS)
Phakic intraocular lens implants
Orthokeratology
Keratoplasty (corneal transplant)

Important: Members must review with Flight Surgeon and get CO approval before LRS. Surgery is NOT funded by CAF.

🔬 Intraocular Lens Implants (IOL) ▼

Certain types of intraocular lens implants are acceptable following cataract surgery provided there are no complications and all visual standards are met. Grounding is required during post-op recovery until at least 7 days after post-operative glasses are prescribed and in use.

IOL Requirements by Aircrew Group

IOL Type	Group A	Group B
Monovision IOLs (including toric IOLs for astigmatism)	✓ Permitted	✓ Permitted
Multifocal IOLs	✗ NOT Permitted	⚠️ May be considered Requires CFEME approval + risk/benefit assessment
Extended Depth of Focus IOLs	✗ NOT Permitted	⚠️ Case-by-case Consult CFEME
Accommodative IOLs	✗ NOT Permitted	⚠️ Case-by-case Consult CFEME

IOLs NOT Permitted for Any Aircrew

IOL Type	Status	Reason
Silicone IOLs	✗ NOT Permitted	Not acceptable for any aircrew duties
Blue Blocker IOLs	✗ NOT Permitted	Blue blocking feature not allowed (standard UV protection is fine)

Return to Flying Requirements

Minimum 7-day grounding after post-op glasses prescribed
All visual standards must be met
No post-operative complications
Group B with multifocal IOL: Functional assessment based on occupational tasks required

Recommendation: Consultation with CFEME is strongly recommended for all aircrew prior to cataract surgery. New IOL options may become available.

Quick Reference: Disqualifying Conditions

Condition	Details
Diplopia	In any field of gaze
Untreated Keratoconus	Or suspicious corneal changes
Glaucoma (uncontrolled)	Optic nerve changes, field loss, or IOP >28 mmHg
Retinal Detachment	History or evidence
Lattice + Myopia >-6D SE	Any degree of lattice with high myopia
Group A: SE >-8.00D or >+3.00D	Including pre-surgery refractive error
Group B: SE >+5.00D	Hyperopia limit
Radial Keratotomy	Disqualifying for all aircrew
Silicone IOLs	Not permitted for any aircrew
Blue Blocker IOLs	Blue blocking feature not permitted
Group A: Multifocal/EDOF/Accommodative IOLs	Only monovision IOLs (incl. toric) permitted for Group A
Polarized Lenses	Prohibited for all aircrew duties
Transition (Photochromic) Lenses	Prohibited for all aircrew duties

Reference: FSG 400-01, AMA 100-01, AMA 400-02. For borderline cases, contact CFEME.

Medications and Aircrew Reference (FSG 1900-01)

Comprehensive medication guidance for Flight Surgeons and BAvMed providers. Last reviewed: September 2025. Aircrew are prohibited from self-medication per Flying Orders.

🩹 Allergy Medicine ▼

Antihistamines

Medication	Status	Grounding	Notes
First-line (non-sedating) Loratadine (Claritin), Fexofenadine (Allegra), Desloratadine (Aerius), Rupatadine (Rupall), Bilastine (Blexten)	✓ Approved	3 days initial	No anticholinergic or CNS effects. No alcohol within 24hrs prior to use. After initial assessment, no restriction for recurrent intermittent use.
Second-line (may cause drowsiness) Cetirizine (Reactine), Clemastine (Tavist)	⚠ Exceptional use only	8 days initial	May produce drowsiness/CNS effects. Only after failed trial of loratadine, desloratadine, or fexofenadine. No alcohol within 24hrs prior to use.
First-generation (sedating) Diphenhydramine (Benadryl), Dimenhydrinate (Gravol), Chlorpheniramine	✗ Not permitted	N/A	Sedating and anticholinergic effects incompatible with flight duties

Allergy Desensitization

Type	Status	Grounding	Notes
SCIT (Subcutaneous Immunotherapy)	✓ Approved	12 hrs after initiation/escalating dose; 4 hrs after maintenance dose	Return to flying only if no adverse systemic effects. May require Geographic Factor TCAT for monthly follow-up.
SLIT (Sublingual Immunotherapy) White Birch (Itulatek), Grass Pollen (Oralair)	✓ Approved	7 days after first dose; 4 hrs after maintenance	Permitted as monotherapy only; dual/multiple therapy not approved. Mild local reactions common but usually abate within 1 hour.

💊 Anesthesia & Pain Medicine ▼

Regional and General Anesthetics

Type	Minimum Grounding	Notes
General, spinal, or epidural anesthetic	72 hours (3 days)	May return if no adverse effects; longer grounding may be needed for surgical recovery
Major peripheral nerve blocks	48 hours	May return if no adverse effects
Short-acting IV sedative (midazolam, ketamine, fentanyl)	72 hours	May return if no side effects
Local/regional anesthetic (minor procedures, dental)	12 hours	May return if no adverse effects

Oral Analgesics

Medication	Status	Grounding	Notes
NSAIDs (Ibuprofen, Naproxen, Oxicams, Celecoxib)	✓ Approved	First week: take after duty, ≥10 hrs before next shift	Condition must not interfere with safe duty performance. After 1 week with no side effects, no restriction for intermittent/ongoing use. Prolonged use (>2 weeks) requires GI protection (PPI or misoprostol). Oxicams and celecoxib acceptable for short or long term use. Brief aircrew on potential GI side-effects.
ASA (Aspirin)	✓ Approved	First week: take after duty, ≥10 hrs before next shift	Same provisions as NSAIDs. Caution on self-medicating with OTC ASA.
Acetaminophen	✓ Approved	None	No restriction required
Muscle Relaxants (e.g., Norflex)	✗ Not permitted	At least 5 half-lives	Not compatible with flying duties due to sedation
Narcotics/Opioids	✗ Not permitted	Based on half-life	Must be fully metabolized before return to flying

❤️ Cardiology ▼

Antihypertensives

Medication Class	Status	Grounding	Notes
Thiazide Diuretics (Chlorthalidone preferred over HCTZ)	✓ Approved	2-4 weeks initial	Long-acting preparations preferred. Ungrounding after 2 weeks if: BP controlled, no side effects, orthostatic vitals normal
ACE Inhibitors / ARBs	✓ Approved	2-4 weeks initial	Same criteria as thiazides. High-G exposure requires repeat G-tolerance assessment
Calcium Channel Blockers (Amlodipine, Felodipine, Nifedipine)	✓ Approved	2-4 weeks initial	Long-acting dihydropyridines only. Not first-line for high-G environment due to vasodilatory effect
Beta Blockers	⚠ Case-by-case	Variable	Generally not recommended due to exercise intolerance; may be considered in specific cases with ASCS review

Lipid-Lowering Agents

Medication	Status	Grounding	Notes
Statins (Atorvastatin, Rosuvastatin, etc.)	✓ Approved	14 days initial	If no side effects (particularly myalgias), no ongoing restriction
Ezetimibe	✓ Approved	7 days initial	May be used alone or with statin
PCSK9 Inhibitors Evolocumab (Repatha)	✓ Approved	2 weeks initial	May be considered for aircrew who do not tolerate statins or fail to reach targets with statin and ezetimibe

🧠 Psychiatry & Mental Health ▼

⚠️ CRITICAL: Local approval for return to flight/controlling for diagnosed mental health disorders is NOT permitted. Must route to ASCS (trained aircrew) or CFEME (untrained).

Antidepressants (FSG 1400-01)

Medication	Status	Grounding	Notes
FIRST LINE - Approved and Preferred
Sertraline (Zoloft)	✓ Approved	A7 until clinically stable on same regimen for minimum 2 months	These medications have had specific aeromedical performance evaluations. Monotherapy preferred. Return to duty assessment per FSG 1400-01
Citalopram (Celexa)	✓ Approved
Escitalopram (Cipralex)	✓ Approved
Bupropion (Wellbutrin)	✓ Approved
SECOND LINE - If first-line not clinically suitable
Duloxetine (Cymbalta)	⚠ Second line	Same as first line	Not aeromedical-specific evaluated but may be used if best clinical choice
Desvenlafaxine (Pristiq)	⚠ Second line
Vortioxetine (Trintellix)	⚠ Second line
NOT APPROVED
Venlafaxine (Effexor)	✗ Not permitted	N/A	Discontinuation effects with missed doses, short half-life
Paroxetine (Paxil)	✗ Not permitted	N/A	Discontinuation effects with missed doses, short half-life
Benzodiazepines, Antipsychotics, Mood stabilizers, Stimulants	✗ Not permitted	N/A	Not compatible with active flight or control positions

Sleep Medications (Operational Use Only - FSG 1400-03)

Medication	Trade Name	Half-life	Dosage	Grounding Required
Temazepam	Restoril	8-9 hrs	7.5/15 mg	12 hours
Zopiclone	Imovane	5 hrs	3.75/5/7.5 mg	12 hours
Zolpidem	Sublinox	2-3 hrs	5 mg	6 hours
Melatonin SR	—	—	1-3 mg SR	Not required (must ground-test first)

Must be ground-tested before operational use (FSG 1400-03 Annex F). Start with smallest dose; max quantity 7. Other antihistamines or benzodiazepines must not be used for sleep. Triazolam (Halcion) prohibited due to hallucination reports.

🔬 Endocrinology / Diabetes ▼

ℹ️ Note: Diabetes is disqualifying for aircrew selection. For trained aircrew, ASCS guidance required for ALL newly diagnosed diabetics.

Diabetes Medications - Treatment Ladder (FSG 900-01)

Step	Medication	Grounding Period	Notes
Lifestyle management	Diet, Exercise, Education	No grounding	First-line for all newly diagnosed
Add Biguanide	Metformin	14 days	First-line medication; safe profile, low hypoglycemia risk
Add DPP4 inhibitor	Linagliptin, Saxagliptin, Sitagliptin	30 days	Low hypoglycemia risk
Add SGLT2 inhibitor	Canagliflozin, Dapagliflozin, Empagliflozin	30 days	Monitor for dehydration/DKA risk
Add GLP-1 agonist	Semaglutide, Liraglutide	30 days initial; 72 hrs each dose increase	Discontinue DPP4i when adding GLP-1a
Add Basal Insulin	Glargine, Detemir	Minimum 90 days; ASCS review; specialist consult mandatory	Requires ASCS approval
Add Bolus Insulin	Lispro, Aspart	Generally disqualifying; Min 180 days; ASCS review	Specialist consult mandatory; high hypoglycemia risk

Sulfonylureas: Generally not approved due to hypoglycemia risk.

🦠 Infectious Disease & Immunology ▼

Antibiotics, Antifungals, Antivirals

Medication	Grounding	Notes
All antibiotics, antifungals, antivirals	4 days minimum	Most serious adverse events occur in first 48 hrs. Must be seen by FS/BAvMed to be ungrounded. Ensure acute illness resolved and no drug side effects.
Fluconazole (Diflucan) – single dose For uncomplicated vaginal candidiasis	24 hours	Single oral dose only. Effective treatment for vaginal candidiasis with shorter restriction.
Minocycline	Avoid	High incidence of vestibular side effects. TMP-SMX can also cause vestibular effects.
HSV treatment/suppression (oral antivirals)	4 days initial	If no side effects, no grounding for intermittent or long-term use

Immunizations

Vaccine	Grounding	Notes
Routine immunizations (Influenza, Yellow Fever, Japanese Encephalitis, etc.)	12 hours	May fly without restriction if no adverse effects
COVID-19 vaccination	48 hours	Also 48 hr no-diving. If adverse effects persist >72 hrs or are severe/atypical, see AvMed provider
Immune globulin (SC/IM)	Not routinely required	IVIG requires AvMed consult before return
Traveler's diarrhea prophylaxis	None	No aircrew restriction needed

Malaria Chemoprophylaxis

Medication	Status	Notes
Atovaquone-Proguanil (Malarone)	✓ Preferred	Preferred agent for aircrew
Doxycycline	✓ Approved	Acceptable alternative
Mefloquine	✗ Not permitted	Neuropsychiatric side effects; not approved for aircrew

🍽️ Gastroenterology ▼

Acid Suppression

Medication	Status	Grounding	Notes
Proton Pump Inhibitors (Pantoprazole, etc.)	✓ Approved	None	Most efficacious for GERD; no grounding required
H2 Blockers (Ranitidine HS dosing)	✓ Approved	None	Acceptable for maintenance therapy
Antacids (Maalox TC, Mylanta II)	✓ Approved	None	No restriction

Active GI ulcer disease requires grounding. Suspected ulcers should undergo endoscopy including H. pylori biopsy.

Motion Sickness

Medication	Status	Notes
Scopolamine (transdermal patch)	⚠ Limited use	May be used for formal airsickness desensitization program or short-term (≤3 days) for sea transport. Requires ground testing.
Dimenhydrinate (Gravol)	✗ Not permitted	Sedating antihistamine; not compatible with flight duties

🚹 Genitourinary / Reproductive Health ▼

Contraceptives (Female)

Type	Status	Grounding	Notes
Oral contraceptives, Hormonal IUDs, Subdermal implants, Injection	✓ Approved	7 days on initiation	If no side effects, no restriction for ongoing use
Emergency contraception - Levonorgestrel (Plan B)	✓ Approved	24-48 hrs	Based on side effects experienced
Emergency contraception - Ulipristal acetate (Ella)	✓ Approved	24-48 hrs	For use within 5 days of unprotected intercourse

Menopausal Hormone Therapy

Menopausal HT (women <60 or <10 yrs post-menopause)

✓ Approved

7 days

When clinically recommended

Benign Prostatic Hypertrophy

Medication	Status	Grounding	Notes
5-alpha reductase inhibitors (Finasteride/Proscar, Dutasteride/Avodart)	✓ Approved	7 days	All aircrew
Alpha blockers (Alfuzosin, Doxazosin, Tamsulosin, Terazosin)	⚠ Restricted	2 weeks	Non-pilots: may return to usual duties if no adverse effects. Pilots: must fly with/as copilot, unfit fast jets

Erectile Dysfunction

Medication	Status	Grounding	Notes
Sildenafil (Viagra), Vardenafil (Levitra)	✓ Approved	48 hrs after each use	Concerns over effects on colour vision
Tadalafil (Cialis)	✗ Not recommended	N/A	Longer half-life (18 hrs) not recommended for actively flying aircrew

👁️ Ophthalmology ▼

Glaucoma Medications

Medication	Status	Grounding
Topical adrenergic agents, Topical beta-blockers, Prostaglandin analogues (Xalatan)	✓ Approved	7 days initial

Examinations

Cycloplegic refraction / Dilated fundoscopy

24 hours

Anticholinergic effects (especially cyclopentolate) may last up to 24 hrs

💪 Dermatology / Rheumatology ▼

Steroids

Type	Status	Notes
Systemic corticosteroids	✗ Not compatible	Not compatible with flight duties for any aircrew
Inhaled and topical intranasal corticosteroids	✓ Approved	No operational flying restriction
Viscous/orodispersible steroids (for eosinophilic esophagitis)	✗ Not permitted	Not permitted for aircrew duties
Anabolic steroids (testosterone for deficiency)	✓ Approved	Initial grounding per pharmacokinetics; monitor levels. Use for body building not permitted.

DMARDs and Biologics

DMARDs and biologic medications require case-by-case ASCS review due to variable side effect profiles and monitoring requirements. All cases should be referred to ASCS at initiation of treatment.

Medication Class	Status	Notes
Methotrexate	⚠ Case-by-case	May be considered for some aircrew with appropriate monitoring; refer to ASCS
TNF-alpha inhibitors	⚠ Case-by-case	6-month TCAT with G/O restrictions during initialization; ASCS review required
Interleukin inhibitors	⚠ Case-by-case	Variable side effects; ASCS review required

Gout Medications

Medication	Status	Grounding	Notes
Allopurinol Gout prophylaxis	✓ Approved	14 days initial	Indicated for prophylaxis after recurrent episodes of gout. Risk of precipitating gout episode during initiation (should generally be done with colchicine coverage). After initial grounding, no ongoing restriction.

🫁 Respirology ▼

Asthma Medications

Medication	Status	Notes
Inhaled corticosteroids	✓ Approved	No restriction for mild, controlled asthma
Short-acting beta-agonists (Salbutamol PRN)	✓ Approved	For rescue use in mild asthma
Long-acting beta-agonists (with ICS)	⚠ Case-by-case	More severe asthma may require grounding and MELs
Oral bronchodilators (Theophyllines)	✗ Not permitted	Not compatible with flying
Long-acting muscarinic agents (for COPD/asthma)	✗ Not permitted for flying	May be considered for ground-based duties only

🧴 OTC & Supplements ▼

Alertness & Caffeine

Substance	Status	Notes
Caffeine	✓ Permitted	Moderate use permitted; max 400 mg/day. Operational use as part of authorized fatigue management per FSG 1400-03
Modafinil, Dextroamphetamine	✗ Not approved	Not approved for CAF aircrew

Supplements

Supplement	Status	Notes
Creatine monohydrate	✓ Approved	No restriction when used as directed
Other herbal/supplements	⚠ Consult FS	Aircrew should consult Flight Surgeon before using any supplements; many contain undisclosed ingredients

Quick Reference – Minimum Temporary Flying Restrictions (FSG 300-01)

Exposure/Procedure	Minimum Grounding
General, spinal, or epidural anesthetic	72 hours
Peripheral nerve blocks (major)	48 hours
Short-acting IV sedative	72 hours
Local/regional anesthetic (minor)	12 hours
Blood donation	72 hours
Platelet/Plasma donation (<450 cc)	24 hours
Bone marrow donation	2 weeks
Simulator	12 hours
Spatial Disorientation training	12 hours
Centrifuge	12 hours
Allergy Desensitization (initiation)	12 hours
Allergy Desensitization (maintenance)	4 hours
Routine Immunization	12 hours
COVID-19 Vaccination	48 hours
Gas Hut training (CS gas)	2 hours
Cycloplegic exam	24 hours
ROBD / CADO	2 hours
Flying after diving	24 hours (rule of thumb)
RUET	4 hours
DCS	Requires aviation medicine provider assessment
Ground pressurization testing	30 min to 48 hrs depending on exposure

Aeromedical Evacuation (AE) Overview

Reference: SOP 417, AE Aide-Memoire, STANAG 3204. Last reviewed: November 2024. The RCMS and RCAF are jointly responsible for timely AE for all CAF members.

Key Principle: Aeromedical Evacuation is defined as the movement of patients under medical supervision by air transportation to and between medical treatment facilities as an integral part of the treatment continuity.

AE Definitions

Type	Definition
Forward AE (Fwd AE)	Airlift for patients between point of injury/illness and the initial point of treatment within the AOR
Tactical AE (Tac AE)	Air transport for patients between MTFs within the AOR (intra-theatre)
Strategic AE (Strat AE)	Air transport from MTFs within the AOR to MTFs outside the AOR, or between MTFs outside the AOR (inter-theatre, including return to Canada)

Key Contacts (24/7/365)

Important: All Strategic AE missions MUST be validated by the 1 CAD Surgeon or designate. Sending/receiving physicians do NOT have authority to initiate requests for civilian AE directly from service providers.

1. AECO (Aeromedical Evacuation Coordinating Officer)

Work: +1 (204) 833-2500 x 257 5728 (business hours)
Mobile: +1 (204) 228-7302 (after hours)
Email: AECO@forces.gc.ca

2. Duty 1 CAD Surgeon

Mobile: +1 (204) 801-8983 (after hours)

3. CAOC (Combined Aerospace Operations Centre)

If AECO and Duty Div Surg cannot be reached:

Work: +1 (204) 833-2500 x 257 2650
Direct: +1 (204) 833-2650
Toll Free: +1 (888) 233-7077
Email: SODO@forces.gc.ca

Strategic AE Process Flowchart

1 Patient requires AE – SMA determines evacuation to higher level of care is needed

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2 SMA sends warning to AECO & Duty 1 CAD Surg (AECO@forces.gc.ca)

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3 Submit AE Request & Initial MEDSITREP to AECO

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4 1 CAD Surg validates AE mission (GO/NO GO decision)

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5 AECO submits RFE to 1 CAD AOC for aircraft (or arranges civilian contracted AE if unavailable)

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6 AE Mission Execution – CF AE Flt crew conducts mission with MSTM support as needed

Sending Physician Checklist

The sending physician is responsible for initiating the AE process and ensuring all documentation is complete.

✓	Task	Notes
	Contact Duty AECO as soon as possible	Notify early to prevent delays
	Determine Move Window	Earliest and latest time patient can be moved (Date/Time Group format)
	Contact Destination Medical Facility (DMF)	Ensure receiving physician and in-patient bed are available
	Contact Base/Wing Surgeon at destination	Discuss patient and pending AE mission
	Submit Strategic AE Request form	Include Initial MEDSITREP with Priority, Classification, Dependency
	AE Mission VALIDATED by 1 CAD Surg or designate	Required before mission proceeds
	Provide Daily MEDSITREP updates	To AECO, Duty Div Surg, Receiving physician, Receiving W/B Surg
	Coordinate ground transport from OMF to flight line	Ensure Level of Care capability is adequate; notify AECO of arrangements
	Notify AECO of any accompanying personnel	Medical personnel, DA, NOK – at discretion of AE Team
	Accompany patient to flightline	Handover documentation, medications to AE Team

Receiving Physician Checklist

✓	Task	Notes
	Receive initial MEDSITREP	From sending physician or Duty 1 CAD Flight Surgeon
	Assist with coordinating local medical care	Ensure receiving physician and in-patient bed are available
	Receive daily MEDSITREPs	Track patient condition prior to arrival
	Coordinate ground transport from flight line to DMF	Ensure Level of Care capability is adequate; notify AECO of arrangements
	Arrange local medical unit rep to meet aircraft	Provide contact info to AECO
	Notify AECO of any VIPs/CoC meeting aircraft	Coordinate additional personnel at destination
	Meet aircraft at flightline	Receive patient and documentation from AE Team
	Accompany patient to DMF	Ensure handover to receiving civilian medical team
	Establish continued follow-up plan	In conjunction with receiving Base/Wing Surgeon

Patient Priority, Classification & Dependency

Reference: STANAG 3204 Amd (Edition 7). These categories must be assigned in the AE Request.

🚨 Priority ▼

Priority	Definition
1 - Urgent	Emergency patients for whom speedy evacuation is necessary to save life, prevent complications, or avoid serious permanent disability
2 - Priority	Patients who require specialized treatment not available locally and who are liable to deteriorate unless evacuated with the least possible delay
3 - Routine	Patients whose immediate treatment is available locally but whose prognosis would benefit from air evacuation on routine scheduled flights

📋 Classification ▼

Neuropsychiatric Patients

Class	Description
1A - Severe	Unstable mental state requiring restraint, sedation, and close supervision
1B - Intermediate	No restraint needed currently but may react badly to air travel or commit acts endangering themselves/aircraft. Need close supervision; may need sedation
1C - Mild	Cooperative and reliable under pre-flight observation

Stretcher Patients (Non-Psychiatric)

Class	Description
2A - Immobile	Unable to move about of their own volition under any circumstances
2B - Mobile	Able to move about of their own volition in an emergency

Sitting Patients (Non-Psychiatric)

Class	Description
3A - Sitting	Sitting patients (incl handicapped) who would require assistance to escape in emergency
3B - Sitting	Sitting patients able to escape unassisted in an emergency

Walking Patients

Class	Description
4 - Walking	Walking patients (non-psychiatric) who are physically able to travel unattended

💊 Dependency ▼

Dependency	Description	Examples
1 - High	Intensive support required during flight	Ventilation, CVP monitoring, cardiac monitoring; may be unconscious or under GA
2 - Medium	Regular, frequent monitoring; condition may deteriorate	Combination of O2, one or more IV infusions, multiple drains/catheters
3 - Low	Not expected to deteriorate but requires nursing care	Simple O2, single IV infusion, urinary catheter
4 - Minimal	No nursing attention required in flight	May need assistance with mobility or bodily functions

Required Information for AE Request

The following information is required for Patient Movement Request (PMR) / Strategic AE Request.

Section A – Patient Information

Name, Rank, SN
Gender, DOB
Parent unit, MOC/MOSID
Patient ID (if applicable)
Move Window: Earliest/Latest date/time patient can be moved

Originating Medical Facility (OMF)

Name of OMF, Ward, Phone
Attending/Referring Physician (Phone, Email)
Referring CAF Physician (Phone, Email)
Admin POC at OMF (Phone, Email)

Destination Medical Facility (DMF)

Name of DMF, Ward, Phone
Attending/Receiving Physician (Phone, Email)
Receiving Base/Wing Surgeon (Phone, Email)
Admin POC at DMF (Phone, Email)

Section B – Mission Information

Priority: 1 (Urgent) / 2 (Priority) / 3 (Routine)
Classification: 1A-1C / 2A-2B / 3A-3B / 4
Dependency: 1 (High) - 4 (Minimal)
Additional AE crew required? (specify)
Special equipment required? (specify)
Altitude restrictions? (specify)
NOK accompanying? (Name, Sex)

Initial MEDSITREP Content

Daily MEDSITREPs must be provided to AECO, Duty 1 CAD Surg, receiving physician, and AE Team. If no changes, communicate this.

📄 Patient General Information ▼

Date, Attending Physician, OMF, Admission Date
Allergies
Relevant past medical history
Medications prior to injury/illness
Diet
Life habits (Tobacco, Alcohol)
Consent to release information: To medical personnel (Y/N), To chain of command (Y/N), NOK notification (Y/N), Limitations

🏥 Clinical Information ▼

Date of injury/illness
Description/Mechanism of Injury/Illness
Initial Injuries / Diagnosis
Physician Notes (including ongoing issues/plan)
Current Medications
Apparatus (lines, tubes, drains, equipment)
Consultation Reports
Operative Procedures
Imaging and Dx Tests
Labs/Hemodynamics
Urine Analysis
Mental Health Issues
Infectious Disease Screening

📝 Daily Updates Section ▼

Record daily progress notes in reverse chronological order (most recent first).

Include: vital signs, clinical status changes, new investigations/results, changes to treatment plan, anticipated move readiness.

AE Team Composition & MSTM

Reference: Admin Instruction – AE Medical Specialist Team Member. The basic AE team consists of Flight Nurse + Flight Med Tech. Additional specialists may be requested.

👨‍✈️ Basic AE Team ▼

Role	Readiness	Location
Primary Basic AE Team (FN + FMT)	12 hours NTM	8 Wing Trenton
Secondary Basic AE Team	48 hours NTM	8 Wing Trenton

🩺 Medical Specialist Team Members (MSTM) ▼

MSTM Type	MOC/MOSID	Required Qualifications
Flight Surgeon (Flt Surg)	00393 Medical Officer	BLS, ACLS, Basic AvMed Course (AJRI), Flight Surgeon Course (ADWS)
Critical Care Medical Specialist	00390 Medical Specialist	BLS, ACLS, Current ICU/IM/Anesth/EM/GenSurg time. Desired: AJRI, ADWS, CCAES Course
Critical Care Nursing Officer (CCNO)	00195-02 NO CC	BLS, ACLS, NO:CC (ADYF), Current CCAES Course or recent AE mission, Current ICU/ER time
Mental Health Nursing Officer (MHNO)	00195-02 NO MH	BLS, ACLS, NO:MH (ADYH), Current MH clinical time. Optional: AE course (AHUT)

MSTM Geographic Areas:

12h NTM: Borden, Kingston, Montreal, Ottawa, Petawawa, Toronto, Trenton
48h NTM: Above + Comox, Edmonton, Gagetown, Greenwood, Halifax, Victoria, Vancouver, Winnipeg

💉 MSTM Readiness Requirements ▼

Current Heart & Stroke Foundation ACLS and BLS for Health Care Providers
High readiness immunizations: Hep A, Hep B, MMR, Meningococcal (booster q5yr), Pertussis, Polio, Seasonal Flu (annually), Typhoid, Td, Yellow Fever, COVID
Current N95 Mask fit testing (expires every 2 years)
If on TCAT with MELs, provide copy to AECO

Alcohol Restriction: No alcohol for at least 12 hours prior to flying, and in no case less than 8 hours prior to reporting for duty. Any alcohol within 24 hours must be moderate and allow body clearance.

Tactical AE (Intra-Theatre)

For movement between MTFs within the Area of Operations.

Minimum Required Information for Tactical AE PMR:

Name/Rank/SN
Date of Birth (DOB)
Unit
Relevant medical history / History of presenting injury or illness
Originating Medical Facility (OMF)
Sending/Referring physician
Destination Medical Facility (DMF) – if known
Receiving physician – if known
Move Window (Earliest/Latest time based on clinical condition)
Additional support/equipment required, if applicable

Routing: Submit PMR to AELO/PECC who will liaise with ACC/ACHQ. Alternatively, submit to 1 CAD AECO if identified as preferred POC during operational planning.

Quick Reference Summary

To initiate AE:	Contact AECO immediately: +1 (204) 228-7302 or AECO@forces.gc.ca
Required forms:	Strategic AE Request + Initial MEDSITREP (both on 1 CAD Surg Website)
Validation required:	All AE missions must be validated by 1 CAD Surg or designate
Daily updates:	MEDSITREP to AECO, Duty 1 CAD Surg, receiving physician, AE Team
Ground transport:	Sending physician coordinates OMF→flightline; Receiving physician coordinates flightline→DMF
Civilian AE:	Only AECO can initiate civilian contracted AE – physicians do NOT have this authority

References: SOP 417 (Procedure for Initiating Strategic and Tactical AE Missions), AE Aide-Memoire for Sending and Receiving Physicians, STANAG 3204, Admin Instruction – AE MSTM, 1 Cdn Air Div Flight Operations Manual Ch 2.

Flight Investigation – BMed/Flight Surgeon Immediate Actions

This section covers immediate investigation points for the Base Medical Officer (BMed) or Flight Surgeon responding to an aircraft occurrence. Reference: A-GA-135-002/AA-001 Occurrence Investigation Techniques, A-GA-135-003/AG-001 Airworthiness Investigation Manual.

⚠️ Important: Medical information collected in flight safety investigations is considered privileged under the Aeronautics Act. Coordinate with the AIA, IIC, and DFS Flight Surgeon regarding information release.

🚨 Immediate Response Checklist

Actions for the responding Flight Surgeon/BMed upon notification of an aircraft occurrence.

CRITICAL FIRST ACTIONS

Patient Care First: Triage and care for survivors takes absolute priority
Coordinate Toxicology Samples: Arrange with Wing Surgeon for toxicology samples of all aircrew (and others as required by IIC – ATC, ground crew, etc.)
Contact DFS Flight Surgeon: Coordinate POCT kit use and specimen collection procedures. Call 1-888-WARN-DFS (1-888-927-6337) for off-hours
Coroner Liaison: If fatalities involved, coordinate with local coroner/medical examiner regarding removal and disposition of remains
Do NOT disturb remains until coroner or CO approval and photographs have been taken
Review CraSH Matrix: Assess crash scene hazards before site entry

Documentation Requirements

Make notes immediately while details are fresh (pencil works best in all weather)
Use audio recorder from Flight Surgeon's Investigation Kit
Arrange colour photography of remains in relation to life support equipment, aircraft structures
Record body location, position, and visible injuries using sketches and photographs
Identify bodies and dismembered parts by name, location stake, and tag

Crash Scene Hazard (CraSH) Matrix – Pocket Guide

Review and revise at minimum when site conditions change and/or at the beginning of each shift on site. Reference: A-GA-135-002 Chapter 6 Annex A.

Hazard	Exposure Route	Risk	Control Measures
Physical Broken structures, Composite fibres (CF), Explosives, Radiological, Stored energy	Cuts, Punctures, Crush, Inhalation/ingestion, Contact/proximity	HIGH Likely Probability, Critical Severity	Control access, Avoid/cordon, Disarm, Decontaminate, No eating on site, Wear PPE, Apply Fixant (CF)
Chemical POL, Metals/oxides, Viton (rubber), Hydrazine	Inhalation, Ingestion, Contact	MEDIUM Likely Probability, Moderate Severity	Control access, Avoid/cordon, Neutralize, Decontaminate, No eating on site, Wear PPE
Environmental Cold/heat, Terrain, Fatigue, Insects/wildlife, Enemy/Security	Variable exposure	MEDIUM Likely Probability, Moderate Severity	Control access, Site security, Work/rest cycles, Feeding/hydration, Insect repellent, Weather-appropriate clothing, PPE
Psychological Traumatic exposure (direct and indirect/vicarious)	Direct exposure, Indirect exposure (narratives)	MEDIUM → May be HIGH with multiple fatalities	Control access, Work/rest cycles, Monitoring, Limit exposure, Control information release, PPE
Biological Blood Borne Pathogens (HIV, Hep B/C)	Cuts, Punctures, Via mucous membranes	LOW Unlikely Probability, Critical Severity	Control access, Decontaminate, No eating on site, Wear PPE, Vaccinate (advance vaccination encouraged/may be mandatory)

Note: Radiological risk is typically LOW (improbable exposure). Psychological effects may manifest well after the investigation – remain vigilant for delayed reactions.

Toxicology & Specimen Collection

Coordinate with DFS Flight Surgeon BEFORE testing. Collection may begin immediately but discuss procedures first.

Flight Surgeon's Investigation Kit Contains:

Accident Investigation Kit: Plotting, audio recording, photographic equipment
Point-of-Care Test (POCT) Kits: Rapid urine toxicology
Medical Specimen Transfer Units (MSTU): For specimen collection and transport

ALL specimen collection must be coordinated with DFS Flight Surgeon

Who Requires Toxicology Samples:

All aircrew
ATC personnel (as required by IIC)
Ground servicing crew (as required by IIC)
Others as directed by IIC

Human Factors Assessment

In the aetiological assessment, the following factors must be considered. Reference: A-GA-135-002 Chapter 4.

🔬 Physiological Factors ▼

Category	Key Assessment Points
Hypoxia	Signs prior to/during accident sequence? Type: Stagnant, Hypemic, Hypoxic, or Histotoxic?
Spatial Disorientation	Vestibular illusions (somatogyral, somatogravic, leans, Coriolis, elevator, giant hand), Visual illusions (black hole, false horizon, height-depth misperception)
G-Effects	History of low G-tolerance? Signs of G-LOC or A-LOC?
Hyperventilation	Signs prior to/during accident sequence?
Decompression Sickness	Recent altitude exposure? Failed pressurization? Recent diving?
Trapped Gas Disorders	Sinus/ear pain, lung issues, GI discomfort during ascent/descent?

😴 Fatigue Assessment ▼

Acute Fatigue

Hours of uninterrupted sleep in last regular sleep period?
Hours elapsed between last sleep period and accident?
Any nap between last sleep and accident flight?
Activity level between last sleep and flight (low/moderate/high)?
Was sleep period interrupted?

Chronic Fatigue

Duty hours in 7-day period prior to accident?
Total sleep hours in 7-day period prior?
Days since last leave period? Duration and type of leave?
Review MALA for FRMS data (coordinate with Operations Group)

Circadian Factors

Time zones crossed within 48 hours?
First night flight after series of day flights?
First day flight after series of night flights?
Irregular waking/sleeping schedules preceding accident?

🧠 Psychological & Psychosocial Factors ▼

Mental State

Mental fatigue (acute or chronic)?
Personality factors affecting performance?
Emotional state (anxiety, anger, depression)?
Attitude issues (complacency, overconfidence)?
Mental limitations (task exceeded capability)?

Psychosocial

Recent significant life events?
Financial stress or legal issues?
Relationship/family changes?
Changes in social habits (drinking, smoking, eating, sleeping)?
Work-related stressors?

💊 Pharmacological Factors ▼

Was pilot taking any drugs or medications at time of accident?
Were these prescribed by a Flight Surgeon or self-medicating?
Purpose: treatment of disease, prevention, weight management, mood alteration, birth control, other?
Any homeopathic supplements or recreational substances?
Alcohol consumption within 24 hours? Amount and timing?

📏 Physical Factors ▼

Anthropometrics: Height, weight, body habitus. Could sitting height, reach, leg length, shoulder width be a factor?
Physical Condition: Fitness level (unfit, average, athletic)?
Physical Strength: Relative strength for age/body type? Could strength be a factor?
Physical Fatigue: Due to prolonged activity, brief extreme activity, or both?
Task Saturation: Did task difficulty or number of tasks exceed physical capacity?
Vision: MELs for vision? Glasses/contacts worn? Current prescription? Wearing at time of accident?

Aircrew Examination

The medical member of the FSI will question and examine aircrew to obtain the following information.

Information to Collect:

Flying and Personal History – refer to B-MD-007-000/AF-003
Injury Description – detail mechanism, correlate with life support equipment damage
Psychological and Physiological Factors – that may have affected aircrew performance

Medical Records Review (Prior to Field Investigation):

Review medical records of all personnel involved
Obtain medical histories
Check for pre-existing conditions, medications, MELs
Review PHA status and any recent medical concerns

Coroner/Autopsy Coordination

Reference: Canadian Forces Health Services Group Orders 4000-09, B-MD-007-000/AF-003.

🏛️ Coroner Liaison ▼

Contact local coroner to determine arrangements for autopsy and custody/transfer of HR
Coroner controls accident site until HR removed and site officially released to IIC
Request approval before disturbing or moving crash fatalities (can be prearranged)
Photograph HR in situ before removal to document state for investigation
Be prepared to assist coroner if unfamiliar with aviation physiology/investigation requirements
Local law enforcement can provide coroner contact information

Note: Photographs of HR shall be very strictly controlled – viewing limited to medical personnel and investigators with "need-to-see" purpose. Photos of HR controlled by DFS Flight Surgeon.

🔬 Post-Mortem Examination Guide ▼

Three elements of aviation post-mortem:

Identification of HR: wallets, clothing, jewellery, age, sex, face, race, hair, eyes, height, weight, dentition, scars, tattoos, blood group, dog tags, etc.
Etiology: Cause of death, pre-existing disease (causal, contributory, or incidental), possible incapacitation or error, intoxication, equipment failure, environmental factors
Determination of Sequential Factors: Gravitational, chemical, thermal, circulatory/respiratory, ante mortem, agonal, post-mortem

Key Autopsy Coordination Points:

Obtain permission from coroner for autopsy
Contact qualified aviation pathologist
Obtain X-rays and/or CT scans to indicate fracture patterns and foreign material
Clothing photographed before removal – can assist victim identification
Note helmet position, pressure marks, fracture lines – determine if retained on head
Provide pathologist with all pertinent technical data surrounding accident

Life Support Equipment Investigation

Conduct in cooperation with qualified Safety System Technician and/or Aeromedical Technician.

Assessment Objectives:

Determine integrity and operation of safety/life support equipment
Ascertain whether equipment contributed to injuries sustained
Question adequacy of equipment to fulfill its function
Correlate equipment damage/function with injuries

Equipment to Examine:

Personal breathing equipment
Escape equipment
Restraining devices (seat belts, harnesses)
Protective helmet
Seats and seat structures
All related sub-systems

Photograph Requirements:

Cabin environment
Seats, seat structures, belt anchorages
Belt buckles
Cabin floor
Cargo restraint
Emergency exits

Handover to FSI Medical Member

The Flight Surgeon who responded to the crash will typically NOT be the one appointed to the FSI. Ensure proper handover.

Critical: Make contact with the appointed FSI Flight Surgeon to pass ALL available medical information collected to that point, including your impressions.

Information to Hand Over:

All notes, sketches, and observations made at the scene
Photographs and recordings
Medical histories obtained
Toxicology sample documentation
Coroner coordination status
Life support equipment findings
Your impressions and hypotheses to that point

FSI Medical Member Responsibilities:

Correlate all information regarding the accident
Submit report to IIC on medical and human factor aspects
List entire relevant sequence of events (known, calculated, probable, or possible)
Discuss with all investigation team members
Reach mutually agreeable solution

Key Contact Information

DFS Flight Surgeon

Off-Hours Line:
1-888-WARN-DFS
(1-888-927-6337)

For toxicology coordination, POCT kit usage, specimen collection, and HR photograph control

Pre-Deployment Liaison

Establish in advance:

Civilian physicians in base area
Hospital locations and capabilities
Local coroners in flying area
Pre-approval for moving remains

References: A-GA-135-002/AA-001 Occurrence Investigation Techniques, A-GA-135-003/AG-001 Airworthiness Investigation Manual, B-MD-007-000/AF-003 Flight Surgeon's Handbook, CF Health Services Group Orders 4000-09 & 7100-01.