1. Part MED IRs and AMCs update January 2019

2. Overview New/Updated Procedures New/Updated Guidance
New/Updated Alternative Means of Compliance
IT changes/Updates to Medical Records System
Changes to documents/forms

3. New/Updated Procedures
Drug and alcohol screening (initial Class 1) – for AeMCs
Please note that the UK has no plans to require testing at revalidation or renewal medicals
ECG now required for all initial Class 2 medicals – will be reflected in MARS and all AMEs are asked to ensure this happens from 30th January 2019 onwards.
New ORL limitation (valid only with a safety pilot if passengers are carried and with aircraft with dual controls) for Class 2 and LAPL
Minor revisions to the wording of several limitations

4. New/Updated Guidance
Changes required in light of new IRs/AMCs or because of developments in medical care:
Medication guidance (incorporating new MED.A.020 material)
Updates to most vision guidance: Eye surgery (particularly cataract surgery), visual fields and binocular vision, contact lens guidance and SpecCalc (to cover both IRs/AMCs changes and developments in medical care)
Please note that the new IRs/AMCs now include requirement for 2 yearly eye examination to include those with refractive error >+5D
New guidance for Thoracic and supra-renal abdominal aortic aneurysms (to cover new IRs/AMCs text)
New guidance for Heart and Heart/Lung transplant guidance for Class 2 (to cover new IRs/AMCs text)
LBBB flowchart for Class 1 & 2 (to cover new IRs/AMCs text)

5. (Cont) New/Update Guidance
Changes required to cover new IRs/AMCs text or because of developments in medical care:
Liver transplant guidance (to cover new IRs/AMCs text)
Guidance for initial Class 1 assessment of hypoacusis (to cover new IRs/AMCs text)
Pneumothorax guidance (routine update)
Coagulation/Haemorrhagic Disorders (to cover new IRs/AMCs text)
Iron Overload States and Haemochromatosis (routine update)
Deep Venous Thrombosis(DVT), Pulmonary Embolism(PE) and use of Warfarin (to cover new IRs/AMCs text)
Depression and Drugs and Alcohol Guidance (to cover new IRs/AMCs text)
Please note the Depression flowchart and Drugs and Alcohol flowchart now include the requirement to add SIC limitations to medical certificates
Psychiatry medical report template (routine update)
Amended the LAPL limitations for insulin treated Type II diabetes from OSL to ORL (to cover new IRs/AMCs text)
Approving a prosthesis (new material)

6. New/Updated Alternative Means of Compliance (AltMOCs)
These enable current practice in the UK to continue (in light of changes to AMC text) or enable assessments to happen in accordance with guidance that has been updated to reflect developments in medical care:
Aortic Stenosis – to allow unrestricted Class 2 certification with moderate disease to continue
Brugada Syndrome – to allow the possibility of Class 1 and 2 certification for asymptomatic type 1 Brugada pattern to continue
Multifocal IOLs - to allow assessment for Class 1 certification following insertion of multifocal IOLs as a result of improvements in surgical outcomes
Update to LAPL Diabetes AltMOC to incorporate the new ORL limitation
Colour vision – current AltMOC maintained

7. IT changes/updates to Medical Records Systems
Update IRs, AMCs and guidance material on our webpages (note Psychiatry and Psychology now appear under the heading Mental Health)
Please note the changes to the structure of the wording of the regulations throughout and especially for haematology, mental health, vision and ENT
Reflecting need for ECG for initial Class 2 medicals in MARS
Adding ORL limitation to MARS and updating text in others
Changes to documents/forms
Minor updates to the Cabin crew attestation & medical report format