Partie A.6. Crew Health Precautions

OPERATIONS MANUAL Part A OMA – A.6.
Ed. N°1 / Mar 19

CREW HEALTH PRECAUTIONS Page 06-1
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Chapitre A.6. CREW HEALTH PRECAUTIONS
© Copyright Nationale Régionale Transport – No duplication without prior authorization

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A.6.0. TABLE OF CONTENT
Chapitre A.6. CREW HEALTH PRECAUTIONS .............................................................................................1

A.6.0. TABLE OF CONTENT.........................................................................................................................3
A.6.1. FOOD ………………………………………………………………………………………………………………………………………6
A.6.1.1. Food precautions before and during the flight..........................................................................7
A.6.1.1.1. Foods to avoid..................................................................................................................7
A.6.1.1.2. Foods to favor..................................................................................................................7
A.6.1.1.3. Fasting..............................................................................................................................8
A.6.2. LIFE STYLE........................................................................................................................................10
A.6.2.1. Sleep and rest: nap....................................................................................................................10
A.6.2.2. Physical activity..........................................................................................................................10
A.6.3. FLIGHT AND SELF-POISONING.......................................................................................................12
A.6.3.1. Alcohol.......................................................................................................................................12
A.6.3.2. Medicines and self-medication..................................................................................................12
A.6.3.3. Substance addiction..................................................................................................................13
A.6.4. VACCINATIONS...............................................................................................................................15
A.6.4.1. International health regulations...............................................................................................15
A.6.4.2. Tropical diseases and vaccination.............................................................................................15
A.6.4.3. Tropical diseases and vaccination.............................................................................................16
A.6.4.3.1. Malaria............................................................................................................................16
A.6.4.3.2. Plasmodium vivax, oval and malaria..............................................................................16
A.6.4.3.3. Plasmodium falciparum..................................................................................................17
A.6.4.3.4. Cholera............................................................................................................................17
A.6.4.3.5. Dengue fever...................................................................................................................18
A.6.4.3.6. The yellow fever.............................................................................................................19
A.6.4.3.7. Hepatitis..........................................................................................................................19
A.6.4.3.8. Schistosomiasis..............................................................................................................20
A.6.4.3.9. Leprosy............................................................................................................................21
A.6.4.3.10. Filariasis..........................................................................................................................22
A.6.4.3.11. Trypanosomiasis.............................................................................................................22
A.6.4.4. Vaccinations...............................................................................................................................23
A.6.4.4.1. Vaccinations recommended for international travel....................................................24
A.6.5. MISCELLANEOUS. .………………………………………………………………………………...26
A.6.5.1. Deep sea diving and flight.........................................................................................................26
A.6.5.2. Blood donation..........................................................................................................................26
A.6.5.3. Surgical operations...................................................................................................................26
A.6.5.4. Alcohol, drug and medication use............................................................................................26
A.6.5.4.1. Vaccinations recommended for international travel....................................................26
A.6.5.5. Narcotics, drugs, sleeping pills, pharmaceutical preparations................................................26
A.6.5.6. Drugs generally unacceptable to crew members.....................................................................27
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A.6.5.7. Drugs generally acceptable to crew members.........................................................................27

A.6.5.8. Vision correction.......................................................................................................................28
A.6.5.9. Sleep and rest............................................................................................................................28
A.6.5.9.1. Chronic fatigue...............................................................................................................28
A.6.5.9.2. Acute fatigue..................................................................................................................28
A.6.5.9.3. Professional fatigue.......................................................................................................29
A.6.5.10. Pregnancy for female crews.....................................................................................................29
A.6.5.11. Assessment of crew radiation exposure level.........................................................................30
A.6.5.12. Surgical procedures..................................................................................................................30
A.6.5.12.1. Different classes of medical certificates.......................................................................30
A.6.5.12.2. Responsibilities of the medical certificate holder.........................................................31

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A.6.1. FOOD
(Cf. RAG 4.1.B.085)
1). The crew member does not perform duties on board an aircraft:
a). when under the influence of psychotropic substances or alcohol or when he is incapacitated due to
injury, fatigue, medical treatment, illness or other similar causes;
b). after diving or donating blood, if a reasonable amount of time has not passed;
vs). if he does not meet the applicable medical conditions;
d). if he doubts that he is in a position to accomplish the tasks assigned to him; or
e). if he knows or suspects that he is tired or if he is not in good condition for another reason, to the
point that the flight may be endangered.
Note : No crew member shall allow their task performance / decision-making capacity to degrade to the
point of endangering flight safety due to the effects of fatigue, taking into account in particular accumula -
tion of fatigue, lack of sleep, number of flight sectors travelled, night work or time zone changes. Rest peri-
ods must be long enough to allow crew members to overcome the effects of previous service and to be
well rested when the next service period begins.
1). A crew member must not:

a). consume alcohol less than 12 hours prior to the time of presentation specified for the flight service or
the start of the reservation;
b). start a flight duty period with a blood alcohol level greater than 0.2 per thousand;
vs). consume alcohol during a flight duty period or while on reserve.
2). Special precautions

An unbalanced diet will lead to digestive disorders which can have an impact on work. In the long run, it
can negatively influence a person’s health and shorten their career.
The qualities of the diet of flight personnel before the flight and during the flight are:
- The easy "digestibility" of food,
- The absence of gas formation, certain foods have this property, we must mention:
• Vegetables: lettuces, radishes, cabbage, celery, turnips, beans, onions, garlic, tomatoes, cucumbers,
spinach;
• Peppers: gray and red pepper;
• Fruits : melons, raw apples, grapes, currants;
• Eggs: especially hard-boiled eggs;
• Cheeses: all, except cottage cheese;
• Desserts: desserts rich in starchy foods.
- A content rich in carbohydrates (a restriction they can decrease alertness during the second half of the
night).
- A protein intake can help limit the decline in alertness during the night.
- During night work, meals high in fat should be avoided.

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A.6.1.1. Food precautions before and during the flight

The first rule in aeronautics is that crew members must not take the same meal tray to avoid the simul -
taneity of sudden incapacity in flight in the event of food poisoning.
The crew should not work with an empty stomach. A meal should be taken one or two hours before
take-off, preferably a light meal which will consist of carbohydrates but low in fat.
A.6.1.1.1. Food to avoid

Refined foods that often lack vitamins, minerals and trace elements:
- white bread
- white rice
- white flour
- white pasta
- white sugar
- …
Sugars hidden in drinks and desserts
Fats hidden in meat, cold cuts and pastries
A.6.1.1.2. Food to favor

Raw foods: slow carbohydrates and fibers that accelerate intestinal transit by retaining water in the di-
gestive tract:
- Whole wheat bread
- whole rice
- unrefined sugars
- Semolina
- Cereals
- Fruit
- green vegetables
Secs pulses
- Natural sugars found in fruit and honey
- Fish and poultry
During the flight, the crew will have to take a lot of fluids, preferably water as neutral as possible, and
fruit juices. Avoid sparkling water, however, and have coffee and tea as a minimum. The crew should eat
lightly and avoid fermentable foods.
On short and medium flights, meals must be taken before the flight and those served on board are not
recommended. On long-haul flights, if and when meals are served, they should not be taken in full, but
avoiding the dishes mentioned above. Light meals and snacks should also be available. At breaks, snacks
and fruit should suffice. The crew should eat at least one hot meal per eight hour flight.
After the flight, the crew is recommended to take a substantial meal, including a good portion of pro-
tein.
Daily in hot countries, food should be less high in calories than in cold or temperate zones. In addition, it
is necessary to drink a lot of water (three to four liters per day) in order to maintain a good hydromin-
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eral balance and sufficient diuresis. Rehydration fluids are recommended, especially in hot and dry coun-
tries, to avoid dehydration
A.6.1.1.3. Fasting
A crew member should not be on board during a fast. When religious reasons dictate it. For example,
during Ramadan, the crew member should take the following precautions:
- Ask to be scheduled for night flights that end before 12.00;
- Limit your activities at night before working;
- Ensure adequate rest and a good meal with lots of fluids just before morning prayer;
- Arrange to be awake on time to have a quiet meal;
- Avoid drinking coffee or tea for the dawn meal as this increases the loss of kidney water. The ideal flu -
ids are water and juice.

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A.6.2. LIFESTYLE
A.6.2.1. Sleep and rest: nap

The nap corresponds to a period of sleep and the duration varies between 30 min and 2 hours.
It plays a decisive role in reducing the need for sleep. It can constitute a compensatory phenomenon in
the event of deprivation of sleep and helps prevent fatigue.
A.6.2.2. Physical activity

For better resistance to stress, it is advisable to increase your heart rate to an "athletic rhythm" for
twenty minutes three times a week. The minimum athletic rhythm corresponds to 180 beats per minute
minus your age: 140 to 40 years for example; the maximum rate is 220 beats per minute minus your age.
Exercising the muscles of the lower limbs, by cycling, swimming, jogging or brisk walking, increases the
heart rate.
The time at which physical activity takes place determines the quality of wakefulness and sleep the fol -
lowing night. It is essential not to get too tired from strenuous physical exercises before a flight, espe -
cially with regard to an evening or night flight. Unusually intense physical activity in the afternoon in-
duces stress which decreases deep slow sleeps the following night in sedentary subjects and increases it
in athletes.
When the physical effort remains moderate and is not too late in the day, fatigue and drowsiness in the
evening are more important and sleep is of good quality.
It is recommended that aircrew members regularly wear compression socks, stockings or tights in order
to limit the problems of varicosity which may be linked to the repetition of flights.

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A.6.3. FLIGHT AND SELF-POISONING
A.6.3.1. Alcohol
Alcohol seriously affects flight skills, mainly causing a false sense of well-being, unnecessary risk-taking,
slower psycho-sensory perception, narrowing of the visual field.
Some people experience the effects of alcohol on their behavior from 0.3 g / l of blood, as benchmarks
and although there is very great interindividual variability (for the same amount of alcohol absorbed,
the rate of blood alcohol level varies for two different people) we can cite the average blood alcohol
levels caused by the absorption of common alcoholic beverages, for a 75 kg man (the blood alcohol
levels add up:
1 half beer (25 cl) = 0,15 g

1 pastis (5 cl) = 0,14 g
1 glass of wine (12 cl) = 0,25 g
1 glass of champagne (8 cl) = 0,15 g
The blood alcohol level reaches its maximum one hour after the last ingestion; it then decreases on av-
erage by 0.15 g per hour, from the second hour.
The rule is not to ingest alcohol within twelve hours before a flight.
A.6.3.2. Medicines and self-medication
In case of self-medication for a common "minor ailment", three questions must be asked before any
flight:
1). Do I really feel able to fly?
2). Do I really need to take medication?
3). Have I tested this medication on the ground at least 24 hours before the flight, to make sure that it
does not cause any effect that could adversely affect my flight ability?
In all cases, during a common minor ailment, it is advisable as far as possible to contact his attending
physician, specifying to him that you are a seafarer, so that he can prescribe a treatment compatible
with the possible continuation aviation activity.
Each of the pharmacopoeial products has very specific indications and a certain number must be con-
sidered as incompatible with theft activity.
A member of the flight crew following any medical treatment must keep the Chief Pilot or the FOPH in-
formed.
A few words regarding hypnotics, tranquilizers, sleeping pills and other psychotropic drugs, avoid their
use anyway without talking to your doctor. Beware of these products, they can prove to be extremely
harmful.

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With regard to "arousing" substances the suggestion, in the current state of knowledge, is to avoid
them.
The drugs that are currently available have extraordinary effectiveness, but on the other hand prove to
have a toxicity that is sometimes just as real. Don't swallow whatever, whenever!
A.6.3.3. Drug addiction

Drug addiction is defined by WHO as "the voluntary, abusive, periodic or chronic absorption, harmful to
the individual and to society, of a drug".
These products have deleterious effects on brain functions, sometimes prolonged for up to 24 hours
after taking such as for example cannabis derivatives.
These products are incompatible with any aeronautical activity because they jeopardize aviation
safety; NRT applies a prohibitive drug addiction policy (zero tolerance).

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A.6.4. VACCINATIONS
A.6.4.1. International health regulations

Since 1981, three diseases have been subject to international health regulations (see RSI 1985 edition):
yellow fever, cholera and the plague. As for the latter, it has become scarce, without having been able
to demonstrate the role of vaccinations.
Time after which the subject
Vaccination Obligation Way of injection validity
is protected
Obligation in many regions of Subcutaneous 10 days after the injection of pri-
Africa (between 15 ° latitude injection in an mo vaccination. The same day if
Antiamarile N and S); in America from approved center revaccination is carried out dur- 10 years
(yellow fever)
Panama state, 15 ° latitude S. only ing this 10-year period.
Obligation removed since 2 subcutaneous 6 days after the first injection.

Anti- 1/1/74, but some countries injections with The same day in the event of re-
6 months
Cholera continue to require it. interval of 12 vaccination carried out during
days the 6 months of validity
A.6.4.2. Tropical diseases and vaccination

Tropical diseases exist only in tropical and subtropical regions (which is the rarest case). More often,
however, they are widespread in the tropics or more difficult to avoid or control. The tropics are re-
sponsible for certain diseases for two reasons:
- tropical climates facilitate certain diseases;
- Areas of poverty and poor sanitation are more common in the tropics.
The most important diseases in the tropical regions of Southeast Asia, Africa, and South America are
malaria, schistosomiasis, leprosy, filariasis, trypanosomiasis, and leishmaniasis.
In addition, warm weather and humid forests favoured the development of flies and mosquitoes that
transmit malaria, yellow fever, dengue, trypanosomiasis, and onchocerciasis.

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A.6.4.3. Tropical diseases and vaccination
A.6.4.3.1. Malaria
1). Definition
Malaria is an infection of red blood cells, caused by a single-celled parasite. Malaria is almost always
caught by the bite of an infected female mosquito, Anopheles, but it is also possible to catch it with con -
taminated blood, or by sharing a syringe that was used previously by an infected person.
2). Transmission
Malaria transmission rates vary depending on local factors such as rainfall (because mosquitoes breed in
wet conditions); the proximity of mosquito breeding areas to humans or depending on the species of
mosquito that prevails in this area. Some regions have a fairly constant number of cases during the year,
they are called "endemic malaria regions". In other regions, there are "malaria seasons" which usually
coincide with the rainy season.
3). Symptoms :
The first symptoms are generally similar to those of the flu: pain and aches, fever, headache, etc. After a
few days, the crisis usually reaches its climax: chills, followed by high fever for a few hours, and then
profuse sweating. Between these attacks, the patient may get better, depending on the type of malaria
they have caught. Some forms of malaria are more severe than others, and depending on the form, the
period between attacks differs. Malaria should be routinely suspected in anyone with these types of
symptoms after traveling to a malaria area.
A.6.4.3.2. Plasmodium vivax, oval and malaria

1). Transmission
By mosquito bite.
2). Symptoms
The incubation period (i.e. the time between the mosquito bite and the development of symptoms) is
variable, normally between 2 and 3 weeks. However, in some cases, the disease takes several months to
manifest. The first symptoms are often similar to those of the flu:
- moderate fever, intermittently;
- headache and a general feeling of being ill (sickness);
- muscle pain and chills.
After 3 to 5 days, the typical malaria attacks begin. They are normally characterized by chills, then fever
(up to 40 degrees Celsius), and then profuse sweating. The attacks normally last between 8 and 10
hours. Between seizures, patients often feel very well.
In Plasmodium vivax and oval malaria, seizures normally occur every 48 hours while with Plasmodium
malaria, seizures occur every 72 hours. The seizures start about the time the red blood cells burst and re-
lease more parasites, which explains the 48- or 72-hour cycles. Subsequently, the body will eliminate
parasites from the blood, and the cracks will become less severe and then disappear.
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A.6.4.3.3. Plasmodium falciparum

1). Transmission
By mosquito bite.
2). Symptoms
Symptoms usually appear 10 to 35 days after a mosquito bite has spread the parasite to a person. There
too, there are the initial symptoms, followed by a malaria attack. However, unlike other forms of mal-
aria, seizures are usually not regular, and patients often have a fever between attacks.
Although P. falciparum also causes red blood cells to burst every 48 hours, it is not as regular as other
forms of malaria, resulting in less well defined seizures. In addition, there are generally more parasites in
the blood with falciparum malaria than with other forms, which partly explains why it is more serious
than the others.
The most important and deadliest of complications is cerebral malaria. Symptoms of cerebral malaria
are:
- high fever;
- severe headache;
- falling asleep;
- A confused and delusional state.

3). Prevention
- Use long-lasting insecticides in homes and buildings
- Place mosquito nets on doors and windows
- Use mosquito nets on the beds. These sails can also be soaked in some insecticides.
- Use mosquito repellents on the skin.
- Wear covering clothes, especially after sunset, to protect as much skin as possible against mosquito
bites. Mosquitoes are said to be generally less likely to bite through white.
Many people living in malaria-infested areas sleep with powerful fans, which seems to discourage mos-
quito bites.
A.6.4.3.4. Cholera
Cholera is an acute disease of the intestinal area. The toxin released by the bacteria causes secretion of
water and mineral salts from the intestines, which results in watery diarrhea. If diarrhea is not treated,
death can occur due to severe dehydration and shock.
1). Transmission
Contaminated water, body fluids or food.
2). Symptoms
Symptoms of cholera can range from moderate to severe and include:
- Severe, very watery diarrhea. Be careful if it looks like rice cooking water or if it smells like fish. It is the
loss of huge volumes of fluids in a very short time that makes it deadly.

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- Nausea and vomiting. They are present at the beginning and at the end of the disease, and can last for
hours.
- Muscle cramps. They are caused by the loss of salts: chlorine, sodium and potassium.
- Dehydration: it can happen in a few hours. Depending on the volume of fluids lost, de-hydration can be
mild or severe.
- Signs of dehydration from cholera. Irritability, lethargy, sunken eyes, dry mouth, extreme thirst, dry,
wrinkled skin, little or no urine, low blood pressure, irregular heartbeat, rapid pulse, dry mucous mem -
branes , an unusual desire to sleep, and in babies, a dark fontanel.
- Shock: hypovolemic shock is one of the most serious complications. It happens when a drop in blood
volume causes a drop in blood pressure, which reduces the amount of oxygen that reaches the tissues.
Untreated, this condition can lead to death.
3). Prevention
Even if there is a cholera vaccine, it offers only limited immunity, and there is still debate over whether
or not travelers should be vaccinated. Good hygiene and clean water is still the best way to prevent in-
fection.
A.6.4.3.5. Dengue fever

1). Definition
Dengue fever, formerly "tropical flu", is an acute disease with an abrupt onset, which is generally mild
and manifests with headaches, fever, fatigue, severe joint and muscle pain, lymph nodes (lymphadeno-
pathy) and redness. The presence of fever, redness and headache (and other pain) (known as the
"dengue triad") is particularly typical of dengue.
2). Transmission
The Aèdes aegypti mosquito.
3). Symptoms
After being bitten by a mosquito infected with the virus, the incubation period varies from 3 to 15 days
(normally 5 to 8) before the signs and symptoms of dengue fever appear. Dengue fever starts with
chills, headache, pain when you move your eyes, and kidney disease. Pain in the legs and joints occurs in
the first hours of the disease. The temperature quickly reaches 40 ° C (104 ° F), with a slow heart rate
(bradycardia) and low blood pressure (hypotension). The eyes are blushing. A pale pink coloration ap-
pears on the face and then disappears. The lymph nodes in the neck and pelvis are often swollen. Fever
and other signs of dengue fever persist for two to four days, then are followed by a rapid drop in tem -
perature (defervescence) accompanied by profuse sweating. This precedes a fever-free episode where
the patient feels well for about a day. Then comes a second bout of fever. Characteristic redness ap-
pears with fever and spreads from the extremities to the whole body - except the face. The palms of the
hands and feet may be bright red and swollen.
4). Prevention

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Same as malaria prevention
A.6.4.3.6. Yellow fever

1). Definition :
An acute, systemic illness (which affects the whole body) caused by a virus called Fla-vivirus. In the most
severe cases, the viral infection causes high fever, bleeding in the skin, and necrosis of cells in the kid -
neys and liver. The damage done to the liver leads to severe jaundice which colors the skin. Hence its
name.
2). Transmission
The Aèdes aegypti mosquito.
3). Symptoms
The incubation period for yellow fever is 3 to 6 days. In the most severe cases, the attack is sudden, with
typical symptoms of headache, back pain, and fever. The first stage is also characterized by nausea,
vomiting, and the presence of albumin in the urine. After the initial fever, the temperature returns to
normal, but on the fourth or fifth day, the temperature rises again. This second stage is marked by jaun -
dice, hemorrhages of the mem-branes, vomiting of blood (the so-called "black" vomit of yellow fever),
and a degeneration of fats from the liver, kidneys and heart. The destruction of liver cells causes the ac-
cumulation of yellow bile pigments in the blood and skin, which explains the name of the disease. Death
normally occurs between the fourth and eighth day after the onset of the crisis.
4). Prevention
Vaccination : take the same precautions as for malaria.
A.6.4.3.7. Hepatitis
1). Definition
Hepatitis is an inflammation of the liver.
2). Transmission
- Food or objects that go into the mouth contaminated;
- Poorly sterilized hypodermic syringes;
- sexual contact;
- A blood transfusion.
3). Symptoms
The incubation period varies depending on the virus in question. Hepatitis A has an incubation period of
15 to 45 days. Hepatitis B has an incubation period of approximately 45 to 160 days, and hepatitis C from
2 weeks to 6 months. Many patients infected with hepatitis A, B, or C have few or no symptoms of the
disease. For those who develop it, the symptoms of viral hepatitis are very similar to those of the flu, for
example:
- loss of appetite ;
- nausea;
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- vomiting;
- fever;
- weakness ;
- tired ;
- pain in the abdomen.
Less common symptoms

- dark urine;
- clear stools;
-fever;
- jaundice (the skin and the whites of the eyes which are yellow).
4). Prevention
Vaccination and good hygiene.
A.6.4.3.8. Schistosomiasis
Also known as bilharziasis. It is a disease of the liver, gastrointestinal tract and bladder.
1). Transmission
It is caused by schistosome parasites, trematode worms found in infected water.
2). Common symptoms

- Redness;
- Itching;
- Fever;
- Chills;
- Cough;
-Muscle aches ;
- Urticaria;
- Enlarged and / or painful liver;
Sometimes no symptoms.
• Symptoms caused by the presence of eggs in the spinal cord

- Convulsions ;
- Paralysis;
- Inflammation of the spinal cord
 For the gastrointestinal system

- Diarrhea;
- Blood in the stool;
- Anemia;
- Dysentery;

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- Hepato-splenomegaly;
- Bladder infection;
- Cystitis - See also the symptoms of cystitis;
- Blood in the urine;
- Kidney stones.
3). Prevention
- Avoid drinking or swimming in standing water.
- A good sanitary environment and control of gastropods.
A.6.4.3.9. Leprosy
1). Definition
Leprosy is a disease caused by the bacteria Mycobacterium leprae which affects the skin and the peri -
pheral nervous system. The disease develops slowly (from six months to 40 years!) And causes skin le -
sions and deformities which most often affect the coldest areas of the body (for example the eyes,
nose, ear lobes, hands, feet, and testicles).
2). Transmission
The exact mechanism of leprosy transmission is unknown. Until recently, the most common theory was
that the disease was spread through contact between infected and healthy people. Recently, the respir-
atory transmission hypothesis has gained ground. There are also other possibilities like transmission via
insects, which cannot be completely ruled out.
3). Symptoms
The leprosy bacteria multiply very slowly, which means that symptoms do not appear until a year after
infection. On average, symptoms appear between 5 and 7 years after infection. After symptoms appear,
they only progress slowly. Leprosy mainly affects the skin and peripheral nerves. Characteristic lesions
and bumps develop. Infection of nerves makes the skin insensitive or weak muscles in the area con-
trolled by infected nerves.
 Tuberculoid leprosy: lesions appear, which consist of one or more flat, whitish areas. The areas
affected by these lesions are insensitive because the bacteria damages the underlying nerves.
 • Lepromatous leprosy: many small bumps or larger swollen lesions of varying size and shape ap -
pear on the skin. There are more numb areas than in tuberculoid leprosy, and some muscle
groups may weaken. Much of the skin and many areas of the body such as the kidneys, nose and
testicles can be affected.
 Borderline leprosy: has manifestations of tuberculoid leprosy and lepromatous both. Left un-
treated, leprosy may become less severe and more like the tuberculoid form, or it may worsen
and become more like the lepromatous form.
4). Prevention
Because leprosy is not very contagious, the risk of contagion is not very high. Only the untreated form is
contagious, even if the infection is not very virulent. Once treatment has started, leprosy cannot spread.

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Avoid contact with bodily fluids and injury to patients, which is the best prevention. BCG (Bacillus
Calmette-Guérin) which is used against tuberculosis offers some protection against leprosy, but is not
often used in this sense.
A.6.4.3.10. Filariasis
1). Definition : Lymphatic filariasis, or elephantiasis, is a parasitic disease caused by microscopic
thread-like parasitic worms.
2). Transmission : Mosquito
3). Symptoms
At first, most people don't suspect they have lymphatic filariasis. They usually don't have any symptoms
until the adult worms die. The disease is not fatal but it can cause permanent damage to the lymphatic
system and the kidneys. Because of the lymphatic system which no longer functions normally, fluid col-
lects and swells the arms, breasts, legs and for men, the genitals. The name of this swelling is lymph-
edema. The entire leg or genital area can swell up to several times its normal size. In addition, the swell-
ing and reduced functions of the lymphatic system interfere with the body's fight against germs and in-
fections. A person with the disease tends to have more bacterial diseases in the skin and the lymphatic
system. This causes the skin to harden and thicken, a phenomenon called elephantiasis.
4). Prevention
Same as for malaria.
A.6.4.3.11. Trypanosomiasis
1). Definition
Trypanosomiasis, also called "sleeping sickness" is an endemic and sometimes epidemic, chronic disease
caused by a protozoan blood parasite of the genus Trypanosome.
2). Transmission
Tsetse fly bites.
3). Symptoms
The disease usually begins with a canker at the bite site, faster heartbeat, enlarged spleen, redness and
fever. In a few months, the nervous system is attacked, with sudden mood changes, a desire to sleep of -
ten, a lack of appetite, and then, a coma frequently followed by death. Symptoms usually appear 1 to 3
weeks after infection.
4). prevention
There is no vaccine that can prevent this disease. Tsetse flies are attracted to rolling vehicles.

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Wear light, but not too light, clothing, up to your wrists and ankles. The fabric should be fairly light and
neutral in color because the tsetse fly is attracted by dark and contrasting colors. Flies are not influ-
enced by insecticides and can bite through thin clothing.
A.6.4.4. Vaccinations
The crew on international flights must be vaccinated against typhoid fever, paratyphoid, tetanus, polio-
myelitis and other indicated diseases in addition to the vaccines required according to international
regulations. All airline personnel at international aerodromes who come into contact with the public
must also be vaccinated.
Note : It is recommended that the pilot of the aircraft immediately notify the health authorities if there is a
case of illness which requires quarantine on board..

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Vaccinations recommended for international travel

1). Typhus
The vaccine is recommended for anyone going to areas known to or suspected of being infected with
typhus transmitted by lice (the epidemic kind). These are Afghanistan, North India, Pakistan, Myanmar,
Korea, China, Ethiopia, Eastern European countries, parts of Africa and South America. It should not be
forgotten that the complete absence of lice is the best protection that exists against typhus.
2). Typhoid and paratyphoid fever
Vaccination is recommended for travel abroad as a personal and public precaution. However, be aware
that a vaccine offers only uncertain and limited protection. Vaccination will not prevent the disease if
you are significantly exposed to it, but its severity can be reduced if booster shots are given every year.
Vaccines produced locally in countries where the infection is found are generally more effective against
the variant disease found locally.
3). Tetanus
Routine vaccination with the tetanus vaccine, also called toxoid or toxoid, is recommended for every -
one. A single booster of 0.5 cubic centimeters of toxoid at intervals of seven to ten years is enough to
maintain good immunity.
4). Poliomyelitis
International travelers, especially children and people under the age of forty, should make sure they are
up to date with their polio immunization.
5). Influenza
Vaccination is recommended, especially for children and the elderly, when they travel to an area where
an influenza epidemic is short or imminent.
6). Diphtheria, whooping cough, measles, hepatitis

Children should be immunized correctly and routinely as a precaution.

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A.6.5. MISCELLANEOUS
A.6.5.1. Deep sea diving and flight

Flying in a pressurized plane after diving can cause decompression sickness (or caisson disease). A crew
member who is not aware of the precautions necessary to avoid caisson disease should not dive within
24 hours of a scheduled flight.
A.6.5.2. Blood donation
Crew members should be aware that there are many restrictions on donating blood, for example:
people who have just had a vaccine, chemical prophylaxis for malaria, etc. Organizing blood donation
should be warned if a crew member decides to donate blood. If acceptable as a blood donor, it is advis -
able not to donate blood within 72 hours before a scheduled flight. (See IATA Medical Manual).
A.6.5.3. Surgical operations
After any surgical intervention, contact your doctor or your medical center for flight crew before you
can resume any aeronautical activity.
A.6.5.4. Alcohol, drug and medication use
A.6.5.4.1. Vaccinations recommended for international travel

No one should ever rejoin the crew of an NRT aircraft after using a narcotic substance or medication
that could harm their faculties in a dangerous way.
No crew member on NRT flight or any temporary contract employee flying on NRT aircraft should ever:
- Consume alcohol less than 12 hours before starting on-call duty for the flight or the flight itself. The
flight is assumed to have started at the time the crew member reports;
- Begin work in flight with a concentration of alcohol in a blood sample taken anywhere on the body
that is greater than 0.02 grams per 100 milliliters;
- Drink alcohol during work in flight, or while waiting for a flight, or less than eight hours after an acci-
dent or an incident which will result in a report which involves the plane, unless the accident or incident
is not related to his duties;
- Drink alcohol in public when he / she is wearing the company uniform.
In order to ensure the strict application of this regulation, NRT reserves the right to carry out alcohol
and drug tests via any necessary means (for example blowing in a balloon, urine test or blood, sighting,
etc.) on any crew member who showed up for their work. Tests will sometimes be done at random and /
or when a crew member is suspected of or observed under the influence of alcohol or a narcotic sub -
stance.
For more details on NRT's Drug and Alcohol Policy and related procedures, see the Health, Safety and
Environment Manual and the Crew Manual, Module 3, Page 18.
A.6.5.5. Narcotics, drugs, sleeping pills, pharmaceutical preparations
By consensus of the majority of physicians, except for the use of harmless medication, a crew member
should not fly if he is taking medication and that he has been placed on sick leave for the illness for
which the medication was prescribed. Many drugs have harmful side effects and are incompatible with
navigation.
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A.6.5.6. Drugs generally unacceptable to crew members

Drugs that affect oxygen use, some drugs like sulfanilamide, phenacetin, and oral anti-diabetic drugs;
Medicines affecting the nervous system, certain antibiotics such as streptomycin, neomycin, kanamycin
and isoniazid; quinine; antihistamines; amphetamines (except in a few special cases); narcotics; barbit-
urates; bromides; tranquilizers and stimulants;
Other drugs; diuretics; hypotension drugs; antiarrhythmics; cardiac glycosides; antispasmodics and ster-
oids.
A.6.5.7. Drugs generally acceptable to crew members
- Simple antacids, sucralfate and colloidal bismuth (temporarily only).
- The commonly accepted systemic antihistamine is Clarityne (but not Clarityne D or any other).
- Zantac taken at bedtime only, and not in the 12 hours preceding a flight. Proton pump inhibitors like
Lanzor may be approved on a case-by-case basis. Please note that the underlying disease is generally
disqualifying if it is active and that pilots can only navigate if they are in the maintenance phase.
- Kaolin preparations.
- Substances that lower cholesterol: fibrates (eg Lopid), HMG coenzyme A inhibitors (eg Zocor). Chole-
stiramine is acceptable but not a priority choice. Lurselle (Probucol) is not acceptable.
- Vitamins, minerals, fatty acids; if they are not taken in combination with preparations containing stimu-
lants.
- Allopurinol.
- Aspirin; as a prophylactic / anticoagulant in small doses, i.e. 75 mg / d.
- Paracetamol (short term). Not during the flight.
- Prophylaxis for malaria (except Lariam and Halfam). The one that is commonly recommended based
on chloroquine alone or chloroquine and Proguanil or chloroquine and doxycycline or Maloprim.
- Low dose oral contraceptives after an initial stabilization period of 3 months.
- Hormone replacement therapy (for replacement of thyroid hormones or estrogen) also requires a sta-
bilization period of three months. Prerequisite: Hormone serum levels must be normal under treatment.
Other hormones and antihormones are generally not acceptable, and will or will not be accepted on a
case-by-case basis.
- A sodium chromoglycate nasal spray, a respiratory inhaler, and eye drops.
- Steroids to inhale (such as the Inflammide).
- Nasal steroid or decongestant sprays (short term).
- Cardioselective beta-blockers: atenolol, acebutalol, etc. Not recommended for acrobatic and fighter pi-
lots.
- Hydrochlorothiazide with triamterene / amiloride. Acceptable for hypertension control in pilots, even if
it is not the first choice of medication. They are not acceptable for other indications, except on a case by
case basis.
- Angiotensin converting enzyme (ACE) inhibitors.
- Anticalcics (except Verapamil).
- Topical preparations (antifungal, antiseptic, antibiotic, steroid, sunscreen, etc.).

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- Vaccination and desensitization (authorization to fly 12 hours after treatment if no side effects or com-
plications have occurred).
- Simple laxatives.
- Carbocysteine.
- Antibiotics: doxycycline (but not minocycline) for acne. For other antibiotics, the underlying condition
and / or the antibiotic is generally disqualifying. Roaccutane is unacceptable.
- Non-steroidal anti-inflammatory drugs: some of the most recent drugs like Mo-bic can be accepted un -
der certain conditions.
A.6.5.8. Vision correction
When corrective lenses are required, the crew member must have a pair of glasses or contact lenses
readily available at their position. It is reminded that an additional spare pair is compulsory for any flight,
if the medical expertise certificate includes the mention "corrective lenses"
A.6.5.9. Sleep and rest
Fatigue is a general term that is difficult to define medically. Normally, fatigue is best, described as a de-
pletion of the body's energy resources, which results in below average performance. Fatigue lowers
driver efficiency, for example, and you should understand the causes and preventive measures.
A.6.5.9.1. Chronic fatigue
Chronic fatigue, over a long period of time, usually has psychological reasons (however, it is sometimes
the fault of an incubating illness), continuous stress from your work, for example, can produce chronic
fatigue. You may experience this condition in the form of weakness, exhaustion, palpitations of the
heart, shortness of breath, headache, or irritability. Sometimes chronic fatigue causes stomach or in-
testinal problems, and generalized pain in the body. When the condition becomes serious, it can lead to
emotional upset. If you think you may be at risk of chronic fatigue, see your doctor. It is rare to be able
to treat yourself alone. Above all, don't fly!
A.6.5.9.2. Acute Fatigue
Acute fatigue, on the other hand, does not last long and is a normal occurrence in everyday life. This is
the kind of tiredness you feel after strenuous exercise, great excitement, or lack of sleep. Rest after ex-
ercise and 8 hours of good sleep can normally remedy the situation.
Acute fatigue has many causes, but the following are the most important for the pilot:
- Low hypoxia (oxygen deficiency)
Physical pressures from the aircraft, such as dealing with severe turbulence, freezing conditions, equip -
ment malfunction.
- Psychological stress
Partly emotional, and partly from the significant intellectual activity required for successful flight opera-
tions.
‒ Lack of physical energy due to psychological stress
Continued psychological stress accelerates glandular secretions and prepares the body for rapid reac-
tions in the event of an emergency. These secretions make the circulatory and respiratory systems work
harder, and the liver releases energy to provide the fuel necessary for the brain and muscles to function
properly. When this reserve of energy is exhausted, the body falls into general and severe fatigue.

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Acute fatigue can be prevented by a balanced diet and a good rest - sleep dosage. A well-balanced diet
prevents the body from having to consume its own tissues as an energy source. Adequate rest main-
tains the body's vital energy stores. The best sleep is in a quiet, comfortable environment. Excitement
and worry will decrease the benefits of sleep. As a pilot, you should sleep at least 8 hours a night. If you
are especially tired, tense or sick, you will need more. Keeping in excellent physical shape will help you
cope better with fatigue. In addition to exercising regularly, you should also avoid being overweight.
Obesity lowers your flight performance, tires your body and shortens your life. If you think you are suf -
fering from chronic fatigue or acute fatigue, stay on the ground until you have recovered your form and
energy!
A.6.5.9.3. Professional fatigue
Special acute fatigue is called "occupational fatigue". It deserves to be mentioned because the pilots
are particularly susceptible to it. Work fatigue has two main effects on your performance:
- A longer reaction time: You seem to accomplish a task as usual but the timing of each operation is
slightly wrong. Apparently, the operation is less easy because you accomplish each task as if it were sep -
arate from the others instead of being integrated into the others.
- Disruption of the field of perception: You focus your attention on movements or objects in the center
of your field of vision and you neglect those which are in the periphery. This can be accompanied by a
loss of acuity and fluidity in the control movements.
The captain will be responsible for ensuring that the flight:

- Will not start if a crew member is unable to do their job due to injury, illness, fatigue, the effects of al-
cohol or medication;
- Will go no further than the next available aerodrome when the crew's ability to perform their duties
during the flight is significantly reduced due to fatigue, illness or lack of oxygen.
A.6.5.10. Pregnancy for female crew members

A female pilot who becomes pregnant must inform the chief pilot within 7 days of confirmation of her
pregnancy. She must provide a medical certificate stating the expected date of delivery.
It is recommended that any pilot who knows he is pregnant, ceases his flight activities.
However, the pilot can also choose to fly between weeks 14 and 26 if his doctor provides written au -
thorization, and if the pilot signs an affidavit which relieves the company of all responsibility for injuries
sustained by him or her / the fetus / baby could suffer in the performance of his duties.
The pilot must comply with the regulations which dictate that the holder of a medical certificate shall
not, under any circumstances, hold any position of flight crew if they are aware of having a medical
problem which could affect the validity of such a medical certificate.
The company doctor must give written permission to resume flights after the baby is born.

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A.6.5.11. Assessment of crew radiation exposure level
Hours at
Altitude in Hours at Hours at Hours at Hours at Hours at Hours at
the
feets latitude latitude latitude latitude latitude latitude
equator
60°N 50°N 40°N 30°N 20°N 10°N
27000 630 747 863 980 1097 1213 1330
30000 440 530 620 710 800 890 980
33000 320 392 463 535 607 678 750
36000 250 308 367 425 483 542 600
39000 200 248 297 345 393 442 490
42000 160 203 247 290 333 377 420
45000 140 180 220 260 300 340 380
48000 120 158 197 235 273 312 350
Note : This table can be used to identify the circumstances in which it is unlikely that an annual
dosage of 1 mSv will be exceeded. If flights are limited to altitudes below 8 km (27,000 ft), annual
doses are unlikely to exceed 1 mSv. No additional control is necessary for crew members whose es -
timated annual dose is less than 1 mSv.
A.6.5.12. Surgical procedures
A.6.5.12.1. Different classes of medical certificates

The expectations and medical standards that must be met by a candidate for, or the holder of, a Class 1,
2, 3 or 4 medical certificates are as follows:
- Discomfort, sudden or mild disability: Applicants must have no risk factors, illnesses or disabilities that
make them unable or suddenly risk making them unable to perform their tasks safely. This may include
the effects and / or side effects of the treatment of any medical condition and the drugs or substances
consumed;
- A medical deficiency: Applicants must not exhibit any of the following symptoms, in the event that this
results in a certain level of functional disability which may interfere with the operation of an aircraft or
with a risk-free performance of their tasks;
- A congenital or acquired abnormality;
- A disability or an active, latent, acute or chronic illness;
- An injury, a wound, or the result of an operation.

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A.6.5.12.2. Responsibilities of the medical certificate holder

The holder of a medical certificate must:
- Carry the certificate with him, in the exercise of his functions as cabin crew, member of the air traffic
service or cabin crew, whatever they may be;
- Not be the captain, or any other flying or cabin crew member whatsoever, if:
- he or she is aware of any medical condition that affects the validity of the certificate he is carrying;
- he or she is under medical treatment;
- the holder is in her thirtieth week of pregnancy;
- the medical certificate is established within the framework of an air traffic service license; or
- an acceptable doctor and an airline medical inspector certify that the holder who has entered his
twenty-ninth week of pregnancy is capable of continuing to exercise as captain or as any other member
of crew or cabin crew for a longer period, even if this period cannot exceed six weeks after the date on
which the staff member entered her thirtieth week of pregnancy;
- the holder gave birth in the previous eight weeks; or
- after a medical certificate has expired.
- Immediately notify the department or the institution of any injury, hospitalization, surgical operation
or invasive procedure, regular use of medication, pregnancy, absence due to illness for a period of more
than 21 days; or, in compliance with the regulations, the holder of a medical certificate must provide the
department or the institution with proof that he or she has completely recovered from his health prob -
lem before being able to resume his duties and the privileges of the license he or she owns.
In conclusion: the advice of a company doctor will be necessary to return to flight duties following any
surgical procedure.

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OPERATIONS MANUAL Part A OMA – A.6.

Ed. N°1 / Mar 19

Chapitre A.6. CREW HEALTH PRECAUTIONS

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A.6.0. TABLE OF CONTENT

Chapitre A.6. CREW HEALTH PRECAUTIONS .............................................................................................1

Ed. N°1 / Mar 19

A.6.5.7. Drugs generally acceptable to crew members.........................................................................27

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1). A crew member must not:

2). Special precautions

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A.6.1.1. Food precautions before and during the flight

A.6.1.1.1. Food to avoid

A.6.1.1.2. Food to favor

Ed. N°1 / Mar 19

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A.6.2.1. Sleep and rest: nap

A.6.2.2. Physical activity

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A.6.3. FLIGHT AND SELF-POISONING

1 half beer (25 cl) = 0,15 g

A.6.3.2. Medicines and self-medication

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A.6.3.3. Drug addiction

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A.6.4.1. International health regulations

Obligation removed since 2 subcutaneous 6 days after the first injection.

A.6.4.2. Tropical diseases and vaccination

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A.6.4.3. Tropical diseases and vaccination

A.6.4.3.2. Plasmodium vivax, oval and malaria

Ed. N°1 / Mar 19

A.6.4.3.3. Plasmodium falciparum

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A.6.4.3.5. Dengue fever

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Same as malaria prevention